Please note: The next available courses will be in July. This application process will be available on the 5th of May, 2010. Please indicate which information session you would like to attend:
Course
Certificate III in Tourism
Certificate III in Hospitality
Certificate III in Business
Location: Sarina Russo Schools, 82 Ann Street Brisbane.

Applicant Details:
Name: *
JSID #: *
Date of Birth: *
Sex: *	MaleFemale
Street Address: *
Suburb: *
Postcode: *
Phone #: *
Mobile #: *
Email:

Eligibility Checklist:
Is applicant 15 years or older? *	Yes No (applicant is not eligable)
Applicant must meet at least one of the following criteria:
Is the applicant an Australian Citizen? *	YesNo
Is the applicant a permanent resident of Australia living in Queensland? *	YesNo
Is the applicant a humanitarian refugee? *	YesNo

Please tick which of the following eligibility criteria apply: *
Registered with an Employment Service Provider An income support recipient who is not currently required to meet activity test       requirements A participant in the Community Development Employment Projects scheme Not currently working and seeking or intending to seek paid employment or self       employment after completing the qualification A participant in the Commonwealth's ACCESS programme Not working but are participating in volunteering activities A person aged 15 - 19 and working up to 15hpw
Applicant Income Support Details:
Please tick the type of Income Support the applicant is receiving *
Newstart Allowance	Youth Allowance
Parenting Payment Single	No Allowance
Other (please state):
Briefly outline why you are referring this jobseeker: *
Applicant's Declaration:

I understand that the personal information collected on this form are for the purposes of my participation in the Productivity Places Program and:
►	is used for Productivity Places Program administration, audit and contract compliance purposes;
►	may be disclosed to and used for these purposes by Productivity Places Program supplier, the Commonwealth Department of Education, Employment and Workplace Relations (DEEWR) and the Queensland Department of Education, Training and the Arts and
►	may otherwise be disclosed without my consent where authorised or required by law.
I may also be asked to participate in a voluntary survey to assess the quality of services provided to me. I acknowledge that providing false or misleading information is a serious offence.
Signature:                                                              Date: 3/09/2010

Referring Agent Details:
Contact Name: *
Phone Number: *
Email Address: *
Fax Number: *
Address: *
Postcode: *
Referring Agent Type (please tick): *
Employment Service Provider (ESP)
Australian Apprenticeship Centre (AAC)
ACCESS Programme Provider
Community Development Employement Provider (CDEP)
Self Referred
Other (please state):
Key marketable points for your jobseeker: *
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Referring Agent's Declaration:
I certify that the applicant has been assessed as being suitable for the Productivity Places Program.
Signature:                                                              Date: 3/09/2010
The information contained in this form is intended only for the nominated recipient. If you are not that person and receive this in error, please notify the sender as soon as possible by phoning 3221 5100