Application Form

PO Box 997N, North Cairns QLD 4870 Phone: 07 4051 6357

Fax: 07 4031 4954 Email: office@totalmantra.com.au

TMT F5.1-1a CSQ Funding Eligibility Checklist Version 7 – 18/05/2017 Page 1 of 1

CSQ Higher Level Skills Eligibility

Checklist This form completed, including all signatures. Copy of birth certificate, passport or visa, or green Medicare card to show citizenship status. Copy of drivers' licence, telephone account, bank statement, real estate agency statement or similar if required. Copy of employer's letterhead or business card, or screen shot of their website to show location of business.

Applicant and Employer Details

Applicant’s Full Name DOB

Applicant’s Address

Employer’s Company Name

Job Title of Applicant Length of Service with Employer

Duties Performed by Applicant

Employer Declaration I can confirm that the applicant listed above has worked for our organisation for one month or more as a full-time, part-time or casual employee or engaged as a contract worker. I can also confirm that the organisation for which the applicant works is part of the building and construction industry and that it is not an Authority or a Registered Training Organisation (RTO). I can confirm the applicant has an active role in construction work, and is not purely an office worker, or employed purely in a clerical role.

The applicant listed above has employment in Queensland: Yes No (Please tick one).

Name Signature Date

Applicant Declaration I have not undertaken any previous funded training or assessment in the qualification I am applying for. I am not participating in a school program, and I have not previously accessed the CSQ Higher Skills Program within the current Contract Term. I am an Australian or New Zealand citizen, permanent resident of Australia or a holder of a refugee or humanitarian visa. I have attached the required evidence of citizenship status and residency. I consent to CSQ contacting me for the purposes of review, to conduct a destination survey, or anything else relating to this funding if required. I understand I may be required to pay for my qualification if I am found to be ineligible for funding.

Name Signature Date

Eligibility Requirement Evidence Requirements

You must be an eligible worker, and an existing worker in the building and construction industry (see definitions for existing workers in the building and construction industry here).

You must complete your employer’s details below and have your employer sign the document to confirm you have worked with them for one month or more.

You must be:

An Australian or New Zealand citizen or

A permanent resident of Australia or

A holder of a refugee or humanitarian visa

You must complete the applicant declaration below and provide evidence or your citizenship, i.e. green Medicare card or a copy of your birth certificate or a passport.

You must be a permanent resident of Queensland or be employed in Queensland.

If you’re employed in Queensland, we simply require a letterhead, business card or website screen shot showing location of the employer’s business (that includes their logo).

Only if your employer is not Queensland based – you must provide a copy of your driver’s licence (or similar photo ID), telephone account, utility bill or any other formal documentation stating your full name and your current residential address in Queensland.

You must not be:

An employee of any Authority or RTO

Currently enrolled and participating in a QLDsecondary school program

A contracted trainer or assessor

Already funded for delivery of the same training

You cannot have already received funding for aqualification under this program within the sameContract Term.

You cannot be employed by a local Council or Government entity. You cannot be employed in a purely administrative role i.e. office workers, contract administrators, etc. are ineligible. Your employer must complete the employer declaration below.

Make sure you attach all these documents!