Please Choose The Course
Provide First Aid
Provide CPR
1. Enter Your Full Name*
* Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI and want [name of RTO] to apply for a USI on your behalf, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose. See section on the USI at the end of this form for a detailed explanation.
2. Enter Your Birth Date
3. Sex (tick one box)
Male
Female
4. Enter Contact Details
5. What is the address of your usual residence?
Please provide the physical address (street number and name not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural area use the address from your state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.
6. What is your postal address (if different from above)?
7. In which country were you born?
Australia
8. Do you speak a language other than English at home?
No, English only
(If more than one language, indicate the one that is spoken most often)
9. How well do you speak English?
1 - Very Well
2 - Well
3 - Not Well
4 - Not At All
10. Are you of Aboriginal or Torres Strait Islander origin?
(For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)
No
Yes, Aboriginal
Yes, Torres Strait Islander
11. Do you consider yourself to have a disability, impairment or long-term condition?
Yes
No - Go to question 13
12. If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:
(You may indicate more than one area)
Hearing/Deaf
Physical
Intellectual
Learning
Mental Illness
Acquired Brain Impairment
Vision
Medical Condition
Other
13. What is your highest COMPLETED school level?
Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent
Year 8 or equivalent
Never attended school - go to question 16
14. In which YEAR did you complete that school level?
15. Are you still attending secondary school?
16. Have you SUCCESSFULLY completed any of the following qualifications?
No - Go to question 18
17. If YES, then tick ANY applicable boxes.
Bachelor degree or higher degree
Advanced diploma or associate degree
Diploma (or associate diploma)
Certificate IV (or advanced certificate/technician)
Certificate III (or trade certificate)
Certificate II
Certificate I
Certificates other than the above
18. Of the following categories, which BEST describes your current employment status?
Full-time employee
Part-time employee
Self employed – not employing others
Employer
Employed – unpaid worker in a family business
Unemployed – seeking full-time work
Unemployed – seeking part-time work
Not employed – not seeking employment
19. Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship?
To get a job
To develop my existing business
To start my own business
To try for a different career
To get a better job or promotion
It was a requirement of my job
I wanted extra skills for my job
To get into another course of study
For personal interest or self-development
Other reasons
From 1 January 2015, we Rainbows Senior First Aid can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI, we can provide one for you by completing the next section.
20. Enter your Unique Student identifier (if you already have one)
1. Enter your Town or City of Birth
(please write the name of the Australian or overseas town or city where you were born)
We will also need to verify your identity to create your USI. Please provide details for one of the forms of identity below and please ensure that the name written in ‘Personal Details’ section is exactly the same as written in the document you provide below.
2. a) Australian Driver Licence
2. b) Medicare Card
Card colour: (select which applies)
Green
Yellow Blue
2. c) Australian Birth Certificate
2. d) Australian Passport
2. e) Non-Australian Passport (with Australian Visa)
2. f) Immicard
2. g) Citizenship Certificate
2. h) Certificate of Registration by Descent
In accordance with section 11 of the Student Identifiers Act 2014, Rainbows Senior First Aid will securely destroy personal information which we collect from individuals solely for the purpose of applying for a USI on their behalf as soon as practicable after we have made the application or the information is no longer needed for that purpose, unless we are required by or under any law to retain it.
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