Incentive Elegibility

	Below is a guide only for elegibility for Australian Government Incentives. Final assessment of elegibility will be determined after finalization and approval of the Training Contract.


	Pre-Assessment of Incentive Elegibility

	Name: *
	Surname: *
	Address: *
	Suburb: *
	State: *
	Post Code: *
	Country: *

	Phone: *	Include Area Code, Ex. 0894503311
	E-mail: *

	Birth Date: *
	Gender: *	Male Female
	Citizenship: *	Australian Citizen or permanent resident
		NZ passport holder who has been resident in Australia for 6 months or more
		Other \| Visa Document Number

	Employer: *
	Employment Status: *
		Total hours per week worked
	Date employment commenced: *
	Department: *
	Position: *
	Supervisor: *

	Have you successfully completed any of the following qualifications?: *
		No Yes Please indicate below
		Bachelor Degree or higher Advanced Diploma or Associate Degree Diploma (or Associated Diploma) Certificate IV (or Advanced Certificate/Technician) Certificate III (or Trade Certificate) Certificate II Certificate I Pre-Apprenticeship/Pre-Vocational Certificates other than the above
	Title and level of qualifications:
	Have you COMMENCED but NOT COMPLETED any qualifications? *
		No Yes Title and level of qualification:

	Are you currently undertaking any other study? *
		No Yes Title and level of qualification:

	What is your highest completed school year? *

	In which year did you complete that school level? *


	Have you previously worked as an apprentice or trainee? *
		No Yes Please provide details below:
	Name of company:
	Title and level of qualification:
	State:
	Year of commencement:
	Apprentice/Trainee number:

	Declaration: *
		I understand that this information may be used by Mission Australia Australian Apprenticeships Centre to pre-assess elegibility of Australian Government Incentives for my employer and any future Australian Apprenticeship I may undertake.

		() All fields are mandatory.*