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PERSONAL DETAILS FORM

ATA Asset Training Australia NEW STUDENT


UPDATE EXISTING STUDENT

All sections of this form are mandatory to comply with the requirements of Asset Training Australia’s record management and reporting
obligations. Please print clearly and use BLOCK LETTERS.

1. STUDENT DETAILS
Name: Title Given Name Middle Name Surname Preferred Name (if different)

Organisation: Company Name Date of Birth

2. CONTACT DETAILS
Phone: Work Mobile Fax Home

Email Address:

3. ADDRESS Tick this box if street address is


the same as postal address
Building Name: Primary Postal Address Primary Street Address

Unit Details:

Street No./Name:

PO Box:

City/Suburb:

State:

Postcode:

4. AVETMISS RELATED DETAILS


Gender: Male Female Native Language: English Other (please specify)
Country of Birth:
..................................................................................
City of Birth:
How well do you Very well
speak English? Well
Citizenship Status: Australian Citizen
Not well
New Zealand Citizen
Not at all
Australian Permanent Resident
Visa (specify type) English Assistance: Yes
.................................................................................. No

Aboriginal or No Attending Other Yes


Torres Strait School/s: No
Aboriginal
Islander Origin:
Torres Strait Islander
Highest Completed year 12 Year completed:
Please continue overleaf...

Employment Full-time employee


COMPLETED Completed year 11
Status: school level:
Part-time employee Completed year 10
Self-employed - not employing others Year 9 or equivalent
Employer Year 8 or below
Employed - unpaid worker in a family business Never attended school
Unemployed - Seeking full-time work
Unemployed - Seeking part-time work
Unemployed - Not Seeking employment

Version 5.0
Disabilities: 6. EMERGENCY CONTACT DETAILS
No Yes (Pease indicate the appropriate areas below) Contact Name:
Hearing/Deaf Acquired Brain Impairment
Physical Vision Relationship:
Intellectual Medical Condition
Learning Other
Contact Number:
Mental Illness

Prior Education:
No Yes (Pease indicate the appropriate areas below) 7. HOW DID YOU HEAR ABOUT US?
Bachelor Degree or Higher Degree level
Advanced Diploma or Associate Degree Level
Diploma Level
Certificate IV
8. AREAS OF INTEREST
Certificate III
Aviation Transport Protection Outdoor Recreation
Certificate II
Business Private Investigations
Certificate I
Business Administration Project Management
Miscellaneous Education
Customer Contact Quality Auditing
Firearms Security Operations
5. STUDENT IDENTIFIERS First Aid Security Risk Management
Unique Student Identifier (USI): Franchising Small Business Management
Human Resources Traffic Management
Learner Unique Identifier (LUI) (QLD secondary school students only): Justice of the Peace Training and Assessment
Leadership Work Health and Safety
Skills for All Number (SA only): Management Other (please specify):
Marketing
.............................................................

8. DECLARATION
The Student Handbook contains information regarding Asset Training Australia's policies and procedures concerning refunds,
support services, privacy, access to records, harassment, discrimination, complaints and appeals. Included with the handbook
are our Code of Practice and our Indemnity Agreement. The Student Handbook is available at our training facilities and on our
website at www.asset.edu.au.
By signing this declaration you acknowledge that you have read, understood and agree to comply with the conditions outlined
in the Student Handbook, the Code of Practice and the Indemnity Agreement.

Date: / /
Please sign here:

OFFICE USE ONLY


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