WORK & LEARNING REGISTRATION FORM

1. CONSENT

Work and Learning Centres (WLC) are a Brotherhood of St Laurence (BSL) initiative funded by the Department of Jobs, Skills, Industry and Regions (DJSIR). In order to support you, the participant, during your time in the program, the Work and Learning Centre staff may be required to share/request/disclose your personal information to organisations/services such as; training providers, employers, labour hire companies, employment service providers (e.g. Workforce Australia, DES, ParentsNext) and welfare services.

Both BSL and DJSIR are committed to protecting personal information consistent with the Privacy and Data Protection Act 2014 (Vic) (PDP ACT). BSL has a Privacy Policy that provides guidelines on the collection, use, disclosure, and security of your information. DJSIR’s Privacy Policy can be found here. If you have any concerns about the way in which DJSIR will handle your information, you can contact a DJSIR privacy officer on (03) 8392 6916 or privacy@ecodev.vic.gov.au.

By completing the information on this form, you are giving consent for the Work and Learning Centre to share your information with the program/service/organisation listed on this form and store your information in a client management system. The system will be accessed by system administrators of the Social Solutions Group in the United States, for the purposes of fixing any system faults, and that the Brotherhood will ensure access by system administrators of the Social Solutions Group is managed in accordance with the Privacy Act.

I understand and agree that DJSIR and Brotherhood of St Laurence may collect, use and disclose information provided by me in accordance with the above Privacy Statement.

I understand and agree that DJSIR and the service provider may ask me to participate in appropriate surveys to establish my progress towards employment.

I understand and consent that my information will be stored in a client management system and may be accessed by system administrators of the Social Solutions Group in the United States, for the purposes of fixing any system faults, and that the Brotherhood will ensure access by systems administrators of the Social Solutions Group is managed in accordance with the Privacy Act. *

I consent to BSL sharing my employment and training information with organisations such as employers, training organisations, group training organisations, employment service providers and welfare services for the purpose of assisting me during my participation in the program. *

I certify the information provided on this form is true and correct at the time of signing *

I give my permission to DJSIR and the service provider to ask me to participate in appropriate surveys. *

YesNo

Consent given by: *

Draw signature|Type signatureClear

Which Work and Learning Centre is closest to where you live? *

2. PERSONAL INFORMATION

Please note that only a few questions are compulsory in this form which are necessary for us to collect. If the question is not mandatory and you are not sure of the answer, you have the option to leave it blank. The Work and Learning Center advisor will talk with you further about those questions later when you have your first appointment.

First Name *

Last Name *

Middle Name

Preferred Name

Phone

Mobile *

Home Address *

Suburb *

Post Code *

Email Address *

3. ADDITIONAL INFORMATION: Visa, Language, Origin

Date of Birth *

Gender *

MaleFemalePrefer to self-describe:

Self-describe:

Eligible Jobseeker means a person who:

(a) is one of the following:

an Australian citizen;
a permanent resident of Australia;
a temporary resident under Australia’s refugee and humanitarian program who holds a visa with the right to work; or
a New Zealand citizen who has been living in Australia for more than 12 months;

(b) is resident in Victoria

(c) has been unemployed for at least twenty six (26) weeks or is underemployed (working less than twelve (12) hours per week in casual or intermittent employment)

Do you fit all these three requirements (a, b & c)? *

YesNo

4. EMPLOYMENT STATUS

Are you currently employed? Tick ‘Yes’ if you worked at least 1 hour in the last week. Those who are employed may still be eligible for this program. *

YesNo

How many hours are you working per week? *

Are you committed to working at least 15 hours per week?

YesNo

5. HOW DID YOU HEAR ABOUT US?

Were you referred by another organisation/service provider? *

YesNo

Please enter the name of the organisation *

If other or service provider, please specify *

Save and Complete Later