First Base Training
Level 6 Suite 609/159-175 Church Street
Parramatta NSW 2150
PO Box 8348, Parramatta Westfield NSW 2150
Phone: 02 9687 8216
Mobile: 0413 859 912
Email: [email protected]
Web: www.firstbasetraining.com.au
APPLICATION FORM
PERSONAL DETAILS – (Please use block letters and provide personal details as shown in passport)
1.
Enter your full name
Family Name (Surname):
Given Name(s):
Day/Month/Year
2.
Enter your birth date
Male □
Female □
3.
Sex (Tick ONE box only)
What is the address of your current residence?
4.
Suburb/Town/City:
Postcode:
Country:
What is your postal address (As above if same).
5.
6.
7.
What is the address of your residence in Australia (if applicable)?
Suburb/Town/City:
What is your postal addressin Australia? (As above if same).
Postcode
Telephone:
Email:
LANGUAGE AND CULTURAL DIVERSITY
7.
In which country were you born?
Town/City of Birth:
Do you speak a language other than English at home? (If more than one language, indicate the one that is spoken most
often.)
8.
8.
No, English only □ If no, go to Question 9
Yes, other - please specify:
How well do you speak English?
9.
Very well
□
Well
□
Not well
□
Not at all
□
DISABILITY
10.
Do you consider yourself to have a disability, impairment or long-term condition?
Yes
□
No
□ If no, go to Question 12
11.
If YES, then please indicate the areas of disability, impairment or long-term condition
Hearing/Deaf
□
Learning
□
Vision
Physical
□
Mental Illness
□
Medical Condition
Intellectual
□
Acquired Brain Impairment
□
□
Other
PREVIOUS SCHOOLING
12.
What is your highest COMPLETED secondary/high school level?
13.
In which YEAR did you complete that school level?
PREVIOUS QUALIFICATIONS ACHIEVED
Have you SUCCESSFULLY completed any other qualifications eg: Certificate,
Yes
14.
Diploma, Degree etc.?
15.
If YES, please specify:
EMPLOYMENT
16.
What BEST describes your current employment status?
STUDY REASON
17.
Describe your main reason for undertaking this course:
Page 1 of 2
Norman Chee & Thu Tram Chee Pty Ltd (trading as First Base Training)
ABN 39 605 858 599
CRICOS 03388F
□
□
□
No
□
ADDITIONAL DETAILS
Passport Number:
Australian Visa Grant
Number (if applicable):
Name and number of next of kin:
Passport
Expiry Date:
Visa Expiry
Date:
Do you have an agent representing you with your enrolment application? (If yes, please provide details
below).
/
/
/
/
□Yes
□ No
Authorised Agent/Representative:
Student’s Address in Home:
Country:
Suburb/Town/City:
Postcode:
Country:
EDUCATIONAL QUALIFICATIONS & ENGLISH LANGUAGE PROFICIENCY
Certified true copies of academic records must be attached. Official English language translations must also be attached if this
documentation has been issued in another language. If your English language score is not equivalent to IELTS 5.5 but is equivalent to
IELTS 4.5 or higher, you will need to complete an ELICOS course from an approved ELICOS provider.
Name of institution
of Qualification:
English Level:
Highest level
achieved:
IELTS □ TOEFL (internet- TOEFL (paper- PTE □ CAE □ OET □
based) □
based) □
Score:
NB: Documentary evidence must be provided or an approved English test taken before Confirmation of Enrolment can be issued.
In order to receive a full offer you are required to provide certified copies of:
1. Personal details and visa pages of your passport
2. Academic transcripts and/or award certificates
3. English language translations of documents not in English
4. English language test results e.g. IELTS, TOEFL, PTE, CAE, OET
5. Australian Visa (if you are already holding a visa)
6. Certified proof of change of name (if applicable)
For details on how to correctly certify the above required documents, please visit our website
www.firstbasetraining.com.au.
Please send your documents along with this application to us either by email to:
[email protected]
Or by mailing (via post) the originals of these documents to:
First Base Training International
Suite 609/159-175 Church Street,
Parramatta NSW 2150
or:
First Base Training International
PO Box 8348, Parramatta Westfield NSW 2150
If you are applying at First Base Training in-person please bring along the originals and
certified copies of your documents.
Page 2 of 2
Norman Chee & Thu Tram Chee Pty Ltd (trading as First Base Training)
ABN 39 605 858 599
CRICOS 03388F