Government Subsidised Training Place Job Seeker Referral Form - Only For Use Invictoria

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Government Subsidised Training Place
Job Seeker Referral Form – Victoria
ONLY FOR USE IN VICTORIA
This form should be used when a Job Services Australia (JSA) Provider wishes to refer a job seeker to a
Government Subsidised Training Place with a Registered Training Organisation (RTO) in Victoria
Part A –To be completed by the referring JSA Provider
Job Seeker & JSA provider contact details
Participant Surname: _______________________ Given Name: ____________________________
Date of Birth: _____________________________ Job Seeker ID: __________________________
Phone Number: __________________________ Mobile Number: ________________________
Email: __________________________________________________________________________
Name of JSA Provider: __________________________________________________________
JSA Provider Employment Consultant: ________________________________________________
JSA Provider Address: _____________________________________________________
Phone Number: ______________ Fax: ____________ Email: ______________________________
JSA Provider Contact Person for Training Fee Invoice________________________
Phone Number: ____________ Fax: _______________ Email: ____________________________
Course selection and eligibility
□
□
JSA Provider has contacted RTO regarding course:
Yes
No
Contact Name: _______________________________Phone Number: ______________________________
Date of Conversation: __________________________Time of Conversation: _________________________
Details of preliminary conversation regarding job seeker eligibility for a government subsidised training place
and suitable courses
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Rationale for course selection
_______________________________________________________________________________________
□
The participant is Not Eligible for a National Partnership Training Place for Single and Teenage Parents
(if they are eligible please complete the Single and Teenage Parents Referral Form and not this form)
RTO and course details
Name of Registered Training Organisation (RTO): _______________________________________________
RTO Address: ___________________________________________________________________________
Course Details
Course Title: ____________________________________________________________________________
_______________________________________________________________________________________
□
□
□
□
Certificate Level:
I
II
III
IV
Other (Please Specify) _____________________
□
□
Course Hours:
Full-Time
Part-Time
Course Start Date: ______________________________ Expected End Date: _________________________
Government Subsidised Training Place Job Seeker Referral Form – Victoria D13/437876
Effective Date: September 2013
S:\STUDENTS\2014\forms\Vic referral form_JSA effective September 2013.docx
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