Register your interest for a Course or Program Register your interest for a Course or Program Thank you for your interest in our course or program. This form is to indicate possible eligibility for training programs at Challenge Employment and Training. Please call us on (07) 3282 8000 if you have trouble filling out the form. Thank you for thinking of us with your next step in your career! Looking forward to working with you in the future! Personal DetailsName* First Last Date of Birth* Gender* Male Female Other Phone Number*Email* Postcode* ZIP / Postal Code Are you an Australian citizen, Australian permanent resident or New Zealand citizen?* Yes No Do you hold a current QLD Drivers Licence?* Yes No What type of licence do you hold?* Learners Provisional 1 (Red) Provisional 2 (Green) Open Previous Qualifications* Certificate I Certificate II Certificate III ( Or Trade Certificate) Certificate IV (Or Advanced Certificate/ Technician) Diploma (Or Associate Diploma) Advanced Diploma or Associate Degree Bachelor Degree or Higher Degree Not Applicable If you have completed the previous qualifications, please tick applicable boxes.What training would you like to undertake?Skilling Queenslanders for Work Community Work Skills Training*(Vocational placement is included in select programs) Cleaning (Domestic Support) - Ipswich Cleaning (Domestic Support) - Underwood Warehousing & Logistics - Ipswich Warehousing & Logistics - Underwood Individual Support (Aged Care) - Kallangur / Deception Bay Individual Support (Aged Care) - Ipswich Engineering - Collingwood Park Electrotechnology - Rocklea Electrotechnology - Rockhampton Electrotechnology - Underwood Construction Traineeship - Redlands Not Applicable Please book into an information session for Individual Support (Aged Care) Ipswich below* Thursday, 11th April 2019 - 10am Monday, 22nd April 2019 - 1pm I can't make the information sessions above, please contact me Please book into an information session for Individual Support (Aged Care) Deception Bay/ Kallangur below* Wednesday, 8th May 2019 - 10am Wednesday, 22nd May 2019 - 10am I can't make the information sessions above, please contact me Please book into an information session for Warehousing & Logistics- Underwood below* Tuesday, 30th April 2019 - 10am I can't make the information sessions above, please contact me Please book into an information session for Electrotechnology - Rockhampton* Tuesday, 4th June 2019 - 10am Tuesday, 4th June 2019 - 1pm Wednesday, 5th June 2019 - 10am Wednesday, 5th June 2019 - 1pm Tuesday, 18th June 2019 - 10am Tuesday, 18th June 2019 - 1pm Wednesday, 19th June 2019 - 10am Wednesday, 19th June 2019 - 1pm I can't make the information sessions above, please contact me Youth Employment ProgramFocuses on helping young people aged 15-21 become work ready or find a pathway back to education. Transition to Work Fee for Service Forklift Training & Licensing 3 day program ($500) Other ProgramHow did you hear about us?* Jobactive provider Community Organisation Social media (Facebook) Social media (Instagram) Eventbrite Word of mouth (e.g. friends, family) Job search website (e.g. SEEK) Apprenticeship Queensland Radio News Paper Other Jobactive provider if applicable:*Name of Newspaper?Please specify:*Please advise what community organisation*PhoneThis field is for validation purposes and should be left unchanged.