If you would like to know more about the program complete this form and one of our team members will contact you shortly. Contact and personal detailsName* First Last Date of birth Day Month Year PhoneEmail* Address line 1 Address line 2 Suburb/town Postcode Employment and studying statusAre you currently employed? Yes No If you're employed how many hours do you work per week?If unemployed, how long has that been? 0-5 months 6-12 month 1-2 years 2 years or more Are you currently studying? Yes No If you're studying how many hours do you study per week?Education historyHighest education level completed - select from listYear 10Year 11Year 12CertificateDiplomaOther Please (specify in the box opposite)If other was selected please specify your highest education level completed Have you trained with us before? Yes (please specify the box opposite) No Not sure Course attended Year attended the course Other information requiredWhere did you hear about us?*GoogleFacebookInstagramCourse guide/brochureOurHub Term GuideLocal newspaperWebsiteEmailCouncil pole bannerFriend (referral)Employment Centre (referral)Careers ExpoHave already attended courses by CireCire Community School referralShop-a-docketOther (specify in the box opposite)If Other was selected please specify below how you heard about us? CommentsPreferred follow up method Telephone Mobile Email CAPTCHA Δ
