ADT Enrolment Form 2015

Thank you for choosing our company as your training provider.

*IMPORTANT NOTE* Please provide correct and accurate information.

As a Registered Training Organisation (RTO), Alltruck Driver Training is required to collect and report data to government agencies or their agents, as part of its registration requirements.

If you require support in Language, Literacy, or Numeracy, please contact us and we will be happy to connect you with training providers offering specialised training courses.

If you have any questions or need assistance, please call 96021177 or email info@adt.nsw.edu.au

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* 1. Enter your full name

Family name (surname)

Given names

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* 2. Enter your birth date

Use dd/mm/yyyy format

Date

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* 3. Sex

Male

Female

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* 4. What is the address of your usual residence?

Please provide the physical address (street number and name not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home.

If you are from a rural area use the address from your state’s or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.

Building/property name

Flat/unit details

Street or lot number (e.g. 205 or Lot 118)

Street name

Suburb, locality or town

State/territory

Postcode

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* 5. What is your postal address (if different from above)?

Building/property name

Flat/unit details

Street or lot number (e.g. 205 or Lot 118)

Street name

Postal delivery information (e.g. PO Box 254)

Suburb, locality or town

State/territory

Postcode

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* 6. In which country were you born?

Australia

Other

Other (please specify)

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* 7. Do you speak a language other than English at home?
(If more than one language, indicate the one that is spoken most often)

English only – Go to question 9

Other

Other (please specify)

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* 8. How well do you speak English?

Very well

Well

Not well

Not at all

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* 9. 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

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

Yes

No – Go to question 12

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* 11. If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list: (You may indicate more than one area)

Hearing/deaf

Physical

Intellectual

Learning

Mental illness

Acquired brain impairment

Vision

Medical condition

Other

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* 12. What is your highest COMPLETED school level? (Tick ONE box only)

Year 12 or equivalent

Year 11 or equivalent

Year 10 or equivalent

Year 9 or equivalent

Year 8 or below

Never attended school – go to question 14

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* 13. In which YEAR did you complete that school level?

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* 14. Are you still attending secondary school?

Yes

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* 15. Have you SUCCESSFULLY completed any of the following qualifications?

Yes

No – go to question 17

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* 16. If YES, then tick ANY applicable boxes.

Bachelor Degree or Higher Degree

Advanced Diploma of Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician)

Certificate III (or Trade Certificate)

Certificate II

Certificate I

Certificates other than the above

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* 17. Of the following categories, which BEST describes your current employment status?

Full-time employee

Part-time employee

Self employed – not employing others

Employer

Employed – unpaid worker in a family business

Unemployed – seeking full-time work

Unemployed – seeking part-time work

Not employed – not seeking employment

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* 18. Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship? (Tick ONE box only)

To get a job

To develop my existing business

To start my own business

To try for a different career

To get a better job or promotion

It was a requirement of my job

I wanted extra skills for my job

To get into another course of study

For personal interest or self-development

Other reasons

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* 19. Enter your email address

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* 20. Enter your phone number/s (at least 1)

Home

Work

Mobile

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* 21. Enter your emergency contact details

Name

Relationship

Phone number

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* 22. Enter the course you're applying for

Medium Rigid - MR (TLILIC2015B Licence to drive a medium rigid vehicle)

Heavy Rigid - HR (TLILIC2016B Licence to drive a heavy rigid vehicle)

Heavy Combination - HC (TLILIC3017B Licence to drive a heavy combination vehicle)

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* 23. Enter the transmission endorsement that you're applying for

Condition B (synchromesh/automatic/automated transmissions)

Unrestricted (all transmissions including constant-mesh)

I am the holder of an unrestricted Medium or Heavy Rigid (MR or HR) NSW licence

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* 24. Enter your NSW driver licence number

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* 25. Enter your NSW driver licence CARD number (located on the top right of your licence)

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* 26. Enter your NSW driver licence expiry date

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* 27. Enter where you FIRST found Alltruck Driver Training?

Google

Yahoo

Brochure

Facebook

Twitter

Word of mouth

YellowPages (print)

YellowPages (online)

The Daily Telegraph

The Land Newspaper

I've been with you before

My employer or colleague booked me in

I saw your vehicle/s on the road

I drove past your building

Logistics forum website

RMS website

Email advertisement

Other (please specify)

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* 28. Enter what MOST made you choose Alltruck Driver Training?

A prompt reply to an email enquiry

Friendly and informative service

Price

Availability

Testimonials

I like what I saw on your website

RTO status

RMS approved provider status

Recommended by someone

Vehicle type or age

I did not choose you, my employer or colleague did

Other

please specify

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* 29. Tick to confirm the following

I declare that the information I have supplied on this form is to the best of my knowledge is correct and accurate.

I acknowledge that before my training and assessment commences, I must have completed the RMS driver knowledge test, and purchased the HVCBA logbook and guidebook for the licence class I am applying for.

I have been informed of fees and charges associated with the course I selected on question 22, or (if applicable) accept that if another party is paying for the course on my behalf, that I will become legally liable for the total cost of the course, should the other party not pay.

I accept that have been made aware of, and I fully understand, the available gearbox licence endorsements (conditions) available concerning heavy vehicle licence outcomes, and I accept that the proposed vehicle used for training will suit my licence and training needs.

I declare that while I am enrolled with Alltruck Driver Training (The Training Provider), I will comply with both its rules and procedures, and rules and procedures imposed by Roads and Maritime Services.

I declare that I have read and understood the Student Handbook.

I provide consent to Alltruck Driver Training (The Training Provider) to release my name, date of birth, contact details, training and assessment records (including video, audio, and GPS evidence) and statistical information to the relevant Government bodies for the purpose of auditing, regulation of training, obtaining feedback and as statistical information.

I declare that I have read and understood the Alltruck Driver Training (The Training Provider) Refund Policy (located in the Student Handbook, on our website, and in the enrolment conformation email)

I acknowledge the fact that reading and understanding the contents of the current RMS publication 'A Guide To Heavy Vehicle Competency Based Training' and any other study resources provided by Alltruck Driver Training (The Training Provider), will strongly support my campaign of successfully completing the training program.

I acknowledge that I must be free from illicit drugs, alcohol and/or medicines that may affect my driving during the training/assessment.

I acknowledge and accept the Alltruck Driver Training (The Training Provider) policy that requires that the learner be well rested prior to undertaking training and assessment in a heavy vehicle. Alltruck Driver Training (The Training Provider) is serious about managing fatigue, and learners who arrive fatigued due to irresponsible behaviours or other circumstances may have their training and assessment program stopped short, which could result in the learner sacrificing their allocated course time. The point to note here is that you as the learner must take all required steps to prepare yourself for driving a heavy vehicle.

I agree to the Roads and Maritime Services advising Alltruck Driver Training (The Training Provider) of my eligibility status? In order to progress, we need to get your permission to contact the Roads and Maritime Services to find out if you are eligible for the assessment, The only information that we will obtain from the Roads and Maritime Services is whether you are eligible to take the assessment. We will not be able to see any other information

I provide consent to Alltruck Driver Training (The Training Provider), including its assessors to record video, audio, and GPS of the licence assessment (FCA/CT), and accept and provide consent to Alltruck Driver Training (The Training Provider) allowing the video, audio, and GPS recording to be retained by Alltruck Driver Training (The Training Provider) inline with Roads and Maritime Services requirements, which is for at least 2.5 years, or longer if deemed necessary by the RTO Chief Executive Officer. It is mandatory that a video camera is used in the cabin of vehicles to capture the on-road components of the FCA/CT as per the HVCBA Accreditation Agreement between Roads & Maritime Services and Registered Training Organisations. This surveillance will be conducted in accordance with the Surveillance Devices Act, Workplace Surveillance Act and Privacy and Personal Information Protection Act.

I acknowledge that in order to undertake Vocational Education and Training I must have a Unique Student Identifier (USI), and I provide consent to Alltruck Driver Training (The Training Provider), including its assessors to verify my USI. If you do not have a USI, as support service, Alltruck Driver Training will assist you with the creation of a USI on the training day and provide you with the relevant privacy policy. Information on USI can be found at usi.gov.au. The applicant for a USI in done online and takes approximately 5 minutes.

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* 1. Enter your full name

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* 2. Enter your birth date

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* 3. Sex

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* 5. What is your postal address (if different from above)?

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* 6. In which country were you born?

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* 7. Do you speak a language other than English at home?(If more than one language, indicate the one that is spoken most often)

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* 8. How well do you speak English?

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* 9. Are you of Aboriginal or Torres Strait Islander origin?(For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)

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

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* 11. If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list: (You may indicate more than one area)

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* 12. What is your highest COMPLETED school level? (Tick ONE box only)

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* 13. In which YEAR did you complete that school level?

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* 14. Are you still attending secondary school?

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* 15. Have you SUCCESSFULLY completed any of the following qualifications?

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* 16. If YES, then tick ANY applicable boxes.

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* 17. Of the following categories, which BEST describes your current employment status?

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* 18. Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship? (Tick ONE box only)

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* 19. Enter your email address

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* 20. Enter your phone number/s (at least 1)

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* 21. Enter your emergency contact details

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* 22. Enter the course you're applying for

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* 23. Enter the transmission endorsement that you're applying for

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* 24. Enter your NSW driver licence number

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* 25. Enter your NSW driver licence CARD number (located on the top right of your licence)

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* 26. Enter your NSW driver licence expiry date

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* 27. Enter where you FIRST found Alltruck Driver Training?

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* 28. Enter what MOST made you choose Alltruck Driver Training?

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* 29. Tick to confirm the following

* 7. Do you speak a language other than English at home?
(If more than one language, indicate the one that is spoken most often)

* 9. Are you of Aboriginal or Torres Strait Islander origin?
(For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)