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 https://www.usi.gov.au/students/create-your-usi/ on computer or mobile device. 2) If single name only, please write in the ‘Family name’ section.
How did you hear about us?
Do you wish to receive email updates/newsletter?
Traffic Control Enrolees
Have you previously held any of the following tickets? If yes, please state expiry date below:
Can you perform traffic control duties in your current employment?
Have you arranged work experience to perform traffic control duties within the next two months?
Declaration and Consent
I understand that I must complete the compulsory pre-course study prior to the course or I may be asked to attend another session at an additional fee.
I understand that I am required to obtain my own work experience in order to satisfy the requirements of this course
If for some reason I cannot obtain my own work experience, I will notify DATS ASAP so that I can get assistance
I understand that I am required to collect specific workplace documentation and keep a logbook of my work experience
I understand that I must attend my allocated assessment date, unless communicated minimum 1 week prior to commencement
I understand that if for some reason I do not attend my allocated assessment date without notification to DATS, a minimum $150 non-attendance fee will be charged
I understand if I attend my allocated assessment day without correct or sufficient workplace samples I will be asked to return at a later date to complete and minimum $150 non-attendance fee will be charged.
I understand I am expected to complete all components of my course within 6 months from the initial training date.
I understand that if I do not attend my allocated assessment date, I may require an extension Statement of completion at an additional cost.
I understand that if I do not complete all aspects of the course within 6 months, I will need to re-sit the course again at an additional cost.
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?
Previous Qualifications Achieved
Have you successfully completed any of the following qualifications? (You may tick more than one)
Do you intend applying for RPL (recognition of Prior Learning)?
Language, Literacy and Numeracy
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.
Do you feel you may need assistance with any aspect of this course?
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.
1. Approximately how many workers are employed at Minezone?
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.
6. The main purpose of this text is:
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.
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?
12. Do you think that the safety program was effective? Explain your answer.
Please contact your local DATS office to make payment before your course commences.
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 www.ncver.edu.au).
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
• 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.comply, without reasonable excuse, with the requirements set out in a written notice.
• Irrespective of who is paying, I am aware of the fees associated with my training course.
I give my consent to DATS to forward a copy of my Statement of Attainment/Statement of Completion
to my employer on my behalf.