Register Students

Course Registration At Jack Barnes Training

011 Provide First Aid & CPR (HLTAID011 – Provide First Aid)

Course Date: 17/03/2021

SRG Group 100 Monash Street, West Wyalong NSW 2671

Duration: 9:00 AM to 4:00 PM

Fee: $150.00

Add Student

To register you in our system, and so we can add this course to your online VET training record (available at www.usi.gov.au) we need to collect some of your details. The Federal Government's standard data questions will follow. Only some questions are mandatory, and these are indicated with a *. Please read and accept the Privacy Notice and press continue.

Section 1. Name and Contact Details

Title *

First Name *

Last Name

The name above is the name that will appear on your Statement of Attainment

Phone/Mobile *

Email *

Confirm Email *

Emergency Contact Name

Emergency Contact Phone

Gender

Section 2. Contact Details

Phone Area

Phone

Fax Area

Fax

Section 2. Residential Details

Company

Unit

Street Number *

Street Name And Type *

Suburb *

State *

Postcode *

Country

Section 4. Postal Address

If your postal address is the same as your residential address, leave blank.

Unit

Street Number

Street Name and Type

PostalSuburb

PostalState

PostalPostcode

Section 5. Language and Cultural Diversity

In which country were you born?

Australia

Other - Please Specify:

Do you speak a language other than English at home?

(If more than one language, indicate the one that is spoken most often)

No, English Only

Yes, Other - Please Specify:

Are you of Aboriginal or Torres Strait Islander origin?

(For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)

Yes, Aboriginal

Yes, Torres Strait Islander

Section 6. Disability

Do you consider yourself to have a disability, impairment or long-term condition?

Yes

Please select the disability area(s) in the following list:

(You may indicate more than one area) Please refer to the Disability supplement for an explanation of the following disabilities.

Hearing/deaf
Physical
Intellectual
Learning
Mental illness
Acquired brain impairment
Vision
Medical condition
Other

Section 7. Schooling

What is your highest COMPLETED school level?

If you are currently enrolled in secondary education, the Highest school level completed refers to the highest school level you have actually completed and not the level you are currently undertaking. For example, if you are currently in Year 10 the Highest school level completed is Year 9.

Are you still enrolled in secondary or senior secondary education?

Yes

Section 8. Previous qualifications achieved

Have you SUCCESSFULLY completed any of the qualifications listed below?

Yes

If YES, 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
Other

Section 9. Employment

Of the following categories, which BEST describes your current employment status?
(Tick ONE box only)

For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours or more per week) or part-time employed (less than 35 hours per week).

Section 10. Study reason

Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship.
(Tick ONE box only)

Section 3. Unique Student Identifier (USI)