Contact: Fendley Skills Development Phone: 07 5559 6404 Fax: 07 5525 6119 Email: training@fendleyskills.com.au Enrolment Form Personal Details First Name: ___________________________ Middle Initial: _______ Surname: ____________________________________________ Address: ____________________________________________________________________State: __________ Postcode: ____________ Country: ___________________ Email: __________________________ Phone Number: ______________ Mobile Number: ___________ D.O.B: / / Gender: __________Driver’s License #: __________ State: __________ Passport #: ___________ Country:___________ Job Title/Role: ____________________________________________ Have you ever attended Well Control School before: Yes No Previous Well Control Course undertaken: ________________ Are you of Aboriginal or Torres Strait Islander Origin: Yes No What language do you speak at home: _______________________ Employer Details Company: _______________________________ Company Contact: ______________________ Address: _________________________________________________________________State: __________ Postcode: ____________ Country: _______________________ Phone Number: _________________________ Email: _________________________________ Are you engaged through Fendley Consultancy as an Employee or Sub‐Contractor: Yes Contractor/Consultant No Employee Sub‐ Course Enrolling into Details Course Title: ___________________________ Course Date: ____________ Please Tick: Classroom Distance Traineeship RPL Online IWCF Well Control Drilling: Level 2 Level 3 Level 4 IADC Drilling Well Control: Fundamental Supervisor Statistical Information Are you still attending secondary schooling: Yes No Name of School you are attending: _________________________________ What is your highest completed school level: ____________ In what year did you complete that school level: ____________________ Since leaving school have you completed any qualifications: Yes No Qualification Name: ________________________________ Current Employment Status: Full‐time employee Part‐time employee Self‐employed employer unpaid family employee unemployed Do you consider yourself to have a permanent and significant disability? Visual/sight Intellectual hearing chronic illness physical other please specify other disability Of the following categories, which BEST describes your main reason for undertaking this course? (Please tick) To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion It was a requirement of my job Document Number & Title: Version Number Last Review: QATrForm1.5 FSD Enrolment form 1 13/10/2014 Date Approved: Next Review: 13/10/2014 13/10/2015 or prn WELL CONTROL – IWCF or IADC ONLY Training Administration Terms & Conditions Information:  Well Control training – IWCF and or IADC – Training provision terms & conditions: o Bookings MUST be made no later than 10 days prior to examination date ( examination date falls on last day of training) o No Payment / No training. o Payment MUST be made at time of Booking. Training will not proceed for persons that have not made FULL Payment prior to date of training. o Cancellations made within 7 days of course commencement date, are Non‐Refundable. All cancellation MUST be received prior to this in writing. o No Refunds or rescheduling of training for persons who do not attend training on scheduled dates, or who fail to complete the booked training program. o If paying by Purchase Oder, bookings will not be confirmed until Payment have been received. o Dress Code: clean, comfortable casual attire – no thongs or tanktops. The following terms and conditions apply to all Other training courses and or participants: 1. Course work progression ‐ Participants are required to notify Fendley Skills Development as soon as it is practical of any event or any difficulties impacting the progress of their training and completion of their unit of competence or training, and if necessary apply for an extension. 2. A fee of $150 will be charged if more than two (2) resubmissions for assessment are required. 3. All cancellations are to be made in writing and should be emailed to admin@fencon.com.au. A full cancellation fee will be charged if the cancellation is made less than 48 hours prior to commencement. A 50% cancellation fee will be charged if the cancellation is made within 7 days of the training. 4. The participants are responsible for the following costs charged by Fendley Skills Development:  Replacement of statement of attainment or issuance while progressing $55 inclusive GST  All participants are given two (2) opportunities to be reassessed without further payment required. On the occasion where participants are unable to demonstrate competency after two (2) re‐assessment attempts they should speak to their trainer about further opportunities to complete the unit. Any further submissions will incur a charge of $150 per attempt.  Participants who are unable to demonstrate competency after two (2) re‐assessment attempts may be required to re‐enrol in that unit and will be charged the additional unit fees 5. Full payment of fees is required prior of the issuance of the Statement of Attainment / Certifications  Participants who successfully complete the unit of competence requirements prior to the planned finished date can receive their statement of attainment on completion, as long as all course fees are paid in full. Refer to Participants Handbook Document Number & Title: Version Number Last Review: QATrForm1.5 FSD Enrolment form 1 13/10/2014 Date Approved: Next Review: 13/10/2014 13/10/2015 or prn