Competency Assessment Application Form

8/8/2019 Competency Assessment Application Form

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Application for Competency Assessment (July 2010)

1. Your occupation

1.1 Title

CA-1Application for Competency Assessment

Barcode (Office use only) Receipt number (Office use only)

2. Your personal details

2.2 Date of birth

/ /

Day Month Year

2.3 Name

Given names

Previous surname or family name (if applicable)

No family nameSurname or family name

FemaleMaleOtherMrsMr Ms Miss2.1 Preferred title

Please read the Explanatory Notes at www.vetassess.com.au before you complete this form.1

Make sure you provide all documents required and sign the photo and declaration.2

When printing this form, set Page Scaling to None in the Print dialog windowIn Adobe Acrobat Reader, see: File > Print > Page Scaling in the Page Handling section

4

To complete the form, please use a black pen and print clearly in BLOCK LETTERS as shown in the example below:3

Mark answer boxes with a cross . If you make a mistake, fill in the entire box and mark the correct box

J O H N S M I T H

Important information about how to complete and print this form

File number (Office use only)

Page 1 0107201002000101

Print


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2.7 Postal address(address where you want

your mail sent this maybe your agent)

PostcodeState

Country

Suburb or town

Postal address

2.8 Home address(if different from your

postal address)

PostcodeState

Country

Suburb or town

Home address

2.4 Country of birth

2. Your personal details continued

2.9 Contact details

Telephone number

Fax number

Mobile phone number

Email address

2.5 Residency status Are you an Australian citizen or permanent resident?

What is your country of citizenship?

Passport number

No

Yes

2.6 Migration Visa If you need a skills assessment for migration purposes, indicate the visa pathway you intend to take.

GSM

ENS

457 Visa

Other

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3. Authorising an agent

3.2 Name of agent or

representative

3.3 Agents company name(if applicable)

3.4 Agents MARA number(if applicable)

Give details below

3.5 Contact details of agent orrepresentative

Telephone number

Fax number

Mobile phone number

PostcodeState

Country

Suburb or town

Address

TRAINING

4. Your general school education

4.1 Secondary and/ortechnical education Number of years

/

Month YearStarted:

/

Month YearFinished:

Name of highestschooling certificate

obtained

Country of education

Email address

Page 3 0107201002000103

3.1 Do you authorise an agentor representative to act foryou in matters concerningthis application (this canbe a family member or amigration agent)

No

Yes

Go to Section 4

I authorise the agent or representative below to act for mein all matters concerned with this application.


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5. Your formal training

No

Yes

5.2 Was this part of anapprenticeship?

5.3 Occupation/Trade

5.4 Name of training program

5.6 Dates of training(or apprenticeship) Number of years

/

Month YearStarted:

/

Month YearFinished:

5.5 Apprenticeship/Traineeship(complete only if yourtraining was part ofan apprenticeship/traineeship)

Name of authority

5.7 Entry requirements

(if relevant)

5.9 Type of trainingFull time study

Part time study

5.8 Course duration Total number of years

Employer/Employmentcontract

PostcodeState

Country

Suburb or town

Address

Company name

Give details below

No

Yes

Go to Section 65.1 Have you completed any

formal training?

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5. Your formal training continued

Campus

PostcodeState

Country

Suburb or town

Address

Name5.10 Training instituteattended

Date completed

/

Month Year

Name5.11 Final exam(if applicable)

5.12 Title of qualificationobtained

5.13 Name of awardingauthority

You will need to attach evidence of completion of this training to your application to page 14.

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6. Other training (e.g. company training, short courses etc)

Dates of training

/Month Year

Started:

/Month Year

Finished:

Name of program

Training institute orcompany

PostcodeState

Country

Suburb or town

Address

Name

Type of trainingFull time study

Part time study

Training duration Course hours

Give details below

No

Yes

Go to Section 76.1 Have you undertaken any

other training programs?


Title of qualificationobtained

Name of awardingauthority

Page 6 0107201002000106

PROGRAM 1


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6. Other training (e.g. company training, short courses etc) continued

Dates of training

/

Month YearStarted:

/

Month YearFinished:

Name of program

Training institute or

company

PostcodeState

Country

Suburb or town

Address

Name

Type of trainingFull time study

Part time study

Training duration Course hours


Title of qualificationobtained

Name of awardingauthority

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PROGRAM 2


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7. Licensing, registration and/or industry membership

Give details below

No

Yes

Go to Section 87.1 Do you hold an

occupational licence,registration or industrymembership?

7.2 Occupation or industryarea

7.4 Title of licence,registration or industrymembership

7.3 Issuing authority

7.5 Description of what thelicence, registration ormembership entitles you

to do

7.6 Dates

/

Month YearIssued:

/

Month YearValid to:

You will need to attach evidence of licence, registration and/or industry membership toyour application to page 14.

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WORK EXPERIENCE

8. Your employment history

YesNo8.2 Are you self-employed?

8.1 Work experience in tradearea

How long have you been working in the trade area you have nominated in this application?

MonthsYears

Your occupation and/orposition held withemployer

8.3 Employment history

EMPLOYER 1Employer name andcontact information

PostcodeState

Country

Suburb or town

Address

Telephone number

Fax number

Contact person

Email address

Company name

Period in occupation

/

Month YearFrom:

/

Month YearTo:

You will need to attachevidence of employmentto your application to p14.

PostcodeState

Country

Suburb or town

Address


Company name

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8. Your employment history continued



/

Month YearFrom:

/

Month YearTo:

Telephone number

Fax number

Contact person

EMPLOYER 2Employer name andcontact informationcontinued



/

Month YearFrom:

/

Month YearTo:




PostcodeState

Country

Suburb or town

Address

Telephone number

Fax number

Contact person

Company name

Email address

Email address

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9. Other information (the following information is required for enrolment and qualification completion purposes)

9.1 Are you of Aboriginaland/or Torres StraitIslander origin?

No

Yes, Aboriginal

Yes, Torres Strait Islander

Yes, Aboriginal and Torres Strait Islander

9.2 Do you speak a languageother than English athome? Which language do you speak at home? If more than one language, please

specify the language that is spoken most often.Yes

No, English Only

9.3 Do you consider yourselfto have a disability,impairment or long termcondition?

Please indicate the area(s) of disability, impairment or long term condition.(Select ALL that apply)

Hearing/Deaf

Physical

Intellectual

Learning

Mental Illness

Acquired Brain Impairment

Vision

Medical condition

Other

No

Yes

9.4 Which of the followingcategories BEST describesyour current employmentstatus?(Select one)

Full-time Employee

Part-time Employee

Self-Employed Not Employing Others

Employer

Employer Unpaid Worker in a Family Business

Unemployed Seeking Full-Time Work

Unemployed Seeking Part-Time Work

Not Employed Not Seeking Employment

9.5 Please indicate if you haveSUCCESSFULLY completedany of the followingqualifications.(Select ALL that apply)

Bachelor Degree or Higher Degree

Advanced Diploma or 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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10. Required Document Checklist

I have included: Identity documents

Certified copy of my Australian drivers licence or relevant biography page from my passport or mybirth certificate

Evidence of change of name (where applicable)

Two (2) recent passport size photographs, certified as a true likeness of myself

Training documentsCertified copy of my training qualifications/certificates in the original language

Certified copy of the transcript or record of results showing subjects, examination results and/orgrades/marks in the original language (where applicable)

Certified copies of any other relevant training

Certified copy of licences, registration or industry membership documentation

Work experience

Original or certified copies of evidence of work experience

Please ensure you have included certified true copies.

Original documents for work experience will be accepted.

Documents will not be returned.

Other

Trade Evidence form for my nominated occupation

Correct payment

Certified translations in English of any of the above documents originally issued in a language otherthan English

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11. Applicants declaration

Please use a paperclip to attach two (2) certified photographs of yourself here.DO NOT STAPLE

I have read and abide bythe above declaration

/ /

Day Month Year

Applicants signature(agents DO NOT sign on behalf of applicant)

Office Use Only Office Use Only

I (print name) declare that:

The information I have supplied on this form and in attachments is complete, correct and up to date.

I have included the required documents as listed on the Required Document Checklist.

All the evidence I have provided relates to me and my work and can be verified.

I have read and understood the information supplied to me in the Explanatory Notes accompanyingthis application.

I will inform VETASSESS of any changes to my circumstances in writing (e.g. change of address) whilemy application is being considered.

I authorise my appointed agent or representative to act in all matters concerned with this application.

I authorise VETASSESS to make any enquiries necessary to assist in the assessment of my skills(including contacting training institutions, employers or other authorities) and to use any informationsupplied for that purpose.

I understand that VETASSESS may verify information relating to this application with any Australianstate or territory licensing or training authority.

I understand that VETASSESS may provide the Department of Education, Employment and WorkplaceRelations (Australia); Department of Immigration and Citizenship (Australia); or the Australian TaxationOffice with any of the information supplied in this application.

I understand that documentation and information submitted in support of my application may bereferred to the Department of Immigration and Citizenship (Australia) for integrity checking.

I understand that my photograph may be taken and/or videotaping/recording may occur during theassessment. This may be used for identity checking and/or for assessment moderation purposes.

I understand that information collected through the assessment process may be provided to Australianstate and federal government for the purposes of statistical data collection.

* I acknowledge that I am undertaking the practical assessment at my own risk and that it is myresponsibility to adhere to safe work practices during the schedules practical assessment. I acknowledgethat it is my responsibility to ensure that at all times during the assessment activities that I worksafety when working on my own and when working with others, and while using any tools andequipment. I agree that VETASSESS and any third party providing services in respect of or hosting theassessment is not liable in respect of any personal injury, death or property damage arising duringthe course of the assessments.

* I have read the information in the Explanatory Notes and/or on the VETASSESS website regarding feesand conditions for assessment, reassessment, review and appeal.

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12. Fees and payment

12.1 I am paying my fees byCredit card Bank draft or bank cheque Money order

Please note that theapplication fee is notrefundable

Credit card typeMasterCard

VISA

Authorisations missing any of the above information will not be processed.

Signature of cardholder

/ /Day Month Year

Name of cardholder

Credit card validationcode

(the last three digits of the number printed on the signature panel)

Credit card

/

Expiry dateNumber

authorise VETASSESS to debit my credit card for the amount of:

as payment for the processing of my Application for Skills Assessment. I understand that the fee isnon-refundable.

12.3 Credit card payment

I,

Name of cardholder

12.2 Amount payable

Calculate the total amountpayable before you makeyour payment

Australian citizen orpermanent resident

Non-citizen ornon-permanent resident

Postage (if applicable)(Select one only)

=

Note: If you select fullpayment but areunsuccessful in meeting therequirements to progress tostage two of the assessment

process, you will receive arefund to the value of thestage two assessment fee.

If you select the two stagepayment, you will beinvoiced for the remainingassessment fee uponsuccessful completion ofstage one of the assessment

process.Registered Australian mail AUD $5.00

Express Post International AUD $16.00(not traceable outside Australia)

Express Courier International AUD $34.00(traceable in major cities outside Australia)

Full payment

Two stage payment

AUD $1200.00

AUD $600.00

Full payment

Two stage payment

AUD $950.00

AUD $400.00

AUD $ 0 0

AUD $ 0 0

AUD $ 0 0

AUD $ 0 0

AUD $ 0 0

TOTAL Amount Payable(add all the above amounts)

AUD $ 0 0

AUD $ 0 0

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After the first stage of the assessment is completed, you will receive further information from VETASSESS explaining stage two of theassessment process.

14. Next stage: Practical Assessment/Technical Interview

13. Submit application

Post your application, withall required documentationand fees, to:

QualityEndorsedCompanyISO 9001 QEC23802

SAI Global

TM

VETASSESSSkills Recognition NationalPO Box 2752

Melbourne VIC 3001Australia

Please indicate where you want to be assessed.

At work

At a TAFE institute

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