Register for a Course or Program Register for a 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. Personal DetailsName* First Last Date of Birth Gender Male Female Other Phone Number*Email* Address* Street Address Suburb ZIP / Postal Code What training would you like to undertake?Skilling Queenslanders for Work Community Work Skills Traineeship(Participants are paid under the National Training Awards) Construction Ipswich Conservation and Land Management Ipswich Migrant Work Skills Pathway Business Program Skilling Queenslanders for Work Community Work Skills Training(Vocational placement is included in the program) Engineering Ipswich Electrotechnology Ipswich Individual Support (Aged Care) Ipswich Individual Support (Aged Care) North Coast (Warner) Logistics Pathway Ipswich Clean Up North Coast Pathway to Security North Coast Certificate 3 Guarantee Business Business Administration Fee for Service Forklift Training & Licensing 3 day program ($500) Employment DetailsAre you currently working? Yes - Full time Yes - Part time Yes - Casual No How many hours do you work per week?How long have you been unemployed?Are you registered with a Job Active/Des Provider? Yes No Please specify your providers name and Jobseeker ID:How long have you been registered with the jobactive/Des Provider?Do you receive any Centrelink Payments? Yes No Which payment do you receive?Do you have a driver licence? Yes No Licence Type:Do you have transportation? Yes No Education DetailsAre you still attending school? Yes No What is the highest level of school you have completed? Year 8 or equivalent Year 9 or equivalent Year 10 or equivalent Year 11 or equivalent Year 12 or equivalent What year did you complete that school level?Have you successfully completed any other qualification? Yes No Qualification details:Language and Cultural DiversityIn which country were you born? Australia Other Please specify:Are you an Australian citizen, Australian permanent resident or New Zealand citizen? Yes No Please specify the visa you are on:Do you speak a language other than English at home? Yes No Please specify:How well do you speak English? Very Well Well Not Well Not at all Do you identify as Aboriginal and/or Torres Strait Islander? Yes No DisabilityDo you consider yourself to have a disability, impairment or long term condition? Yes No Other DetailsHow did you hear about us? Jobactive provider Community Organisation Social media (Facebook, Instagram) Word of mouth (e.g. friends, family) Job search website (e.g. SEEK) Other Please specify:NameThis field is for validation purposes and should be left unchanged.