Student Enrolment Form


All sections must be completed by the applicant on online form below. If you have trouble with
online form, please download Student Enrolment pdf form and email

Student Details


How did you hear about us?

Emergency Contact

Do you wish to receive email updates/newsletter?

Cultural Diversity



Are you currently attending school?



Which of the following best describes your current employment status? Note, for casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full-time (35 hours or more) or part-time employee (less than 35 hours per week).



Do you speak another language other than English at home?


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

Previous Qualifications Achieved

Have you successfully completed any of the following qualifications? (You may tick more than one)

Study Reason


Do you intend applying for RPL (recognition of Prior Learning)?

Language, Literacy and Numeracy

Do you feel you may need assistance with any aspect of this course?

DATS may be able to assist participants who are not confident in their language, literacy or numeracy skills.
It is important to advise DATS of any learning difficulties or special requirements (you may have) as soon as possible prior to the scheduled training date. 


The following graph shows the number of workplace injury incidents during 2008. This covers all incidents ranging from very minor incidents (e.g. cuts and bruises) to more serious ones requiring hospitalisation. Look at the graphs and answer the following questions.


Privacy Notice

Under the Data Provision Requirements 2012, Dickens Assessment and Training Services (DATS) is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER).

Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by DATS for statistical, regulatory and research purposes. 

DATS may disclose your personal information for these purposes to third parties, including:   School – if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship;   Employer – if you are enrolled in training paid by your employer; Commonwealth and State or Territory government

departments and authorised agencies; NCVER; Organisations conducting student surveys; and Researchers.
Personal information disclosed to NCVER may be used or disclosed for the following purposes:

Issuing a VET Statement of Attainment or VET Qualification, and populating Authenticated VET Transcripts;

facilitating statistics and research relating to education, including surveys; understanding how the VET market operates, for policy, workforce planning and consumer information; and administering VET, including program administration, regulation, monitoring and evaluation.

You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. You may opt out of the survey at the time of being contacted. 

NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at

Student Declaration and Consent

•  I declare that the information I have provided is true and correct. I am aware of the consequences that may arise from providing false, 

   misleading or incomplete information.

•  I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.

•  I have notified DATS if I have any disability, physical impairment, language, literacy or numeracy problems, or any health  

   problems/conditions which may affect my training. 

•  I have read and understood the Student Handbook (available on our website).

•  I have read and understood the course flyer for the course in which I am enrolling (available on our website).

•  I meet the pre-requisites for the course in which I am enrolling (if applicable).

•  I agree to my photo or comments in the evaluation sheet being used for promotional purposes.

•  I understand I am required to present appropriate Identification on the day of the course i.e. Driver’s Licence.

•  I give DATS permission to undertake a search for my USI.

•  I understand that SafeWork NSW or WHS QLD may request that a High Risk Work Licence holder be re-assessed anytime and that

   SafeWork NSW or WHS QLD may suspend, cancel, refuse to issue or renew a High Risk Licence if the licence holder refuses or fails to

   comply, without reasonable excuse, with the requirements set out in a written notice.

•  I am aware, accept and understand that training activities conducted by Dickens Assessment & Training are potentially hazardous,       

   physically strenuous and/or emotionally stressful. I accept all hazards as briefed to me, relating to, associated with or arising from my

   participation in such activities or practical exercises.

•  Irrespective of who is paying, I am aware of the fees associated with my training course.

Please contact your local DATS office to make payment before your course commences.

Please read the following text and answer the LLN Indicator questions:

Minezone is a large mining company that employs approximately 7000 workers. The company has become increasingly concerned about workplace safety as there had been a growing number of incidents, including one death in 2007. Minezone’s CEO, Martha Henderson, was committed to improving the safety of their workers, so in 2008 they undertook a large scale training program to educate their workforce about work safety. Some successful aspects of the program included:

•  all workers were given the opportunity to offer their point of view on what would make a difference to their safety in the workplace

•  all workers were retrained in aspects of safety 

•  a system of rewards was offered to work teams that demonstrated a decrease in the number of workplace incidents

•  new workers were provided with extensive training in the correct use of equipment. 


12. Do you think that the safety program was effective? Explain your answer.

2.  In what year did the death of a worker occur?

3.  What was Minezone’s management committed to?

4.  Who is the CEO of Minezone?

5.  Note two successful aspects of the workplace safety program.

1.  Approximately how many workers are employed at Minezone?

I give my consent to DATS to forward a copy of my Statement of Attainment/ Statement of Completion
to my employer on my behalf.

7. Which month had the highest number of workplace injuries?

8. Which month had the lowest number of workplace injuries?

9. What is the total number of injuries in September and October combined? Show your working out.

10. What is the difference in the number of incidents between July and October 2008?
Show your working.

11. What is the general trend in the number of incidents?

Company/Employer Details

6.  The main purpose of this text is: 


NOTE: 1) Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI please apply at on computer or mobile device. 2) If single name only, please write in the ‘Family name’ section.

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