Personal Details
Title:
Given Name:
Middle Name:
Last Name:
Date of birth:
Unique Student Identifier:
Info
Gender:
Email:
Info
District:
Mobile:
Home Phone:
Work Phone:
Member Number:
Brigade:
CFA Employee Number:
Usual Residential Address
Please provide the physical address (street number and name not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural area use the address from your state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.
Building/property name:
Info
Flat/unit details:
Street or lot number:
Street Name:
Suburb, Locality or Town:
Postcode:
State/Territory:
Country:
Copy Residential Address to Postal:
Copy Residential Address to Postal
Postal Address
Building/Property Name:
Info
Flat/Unit Details:
Street or Lot Number:
Street Name:
Postal delivery information (PO box):
Suburb, Locality or Town:
State/Territory:
Postcode:
Country:
Emergency Contact
Contact Name:
Relationship:
Contact Number:
Citizenship
Country of Birth:
City of Birth:
Citizenship Status:
Country of Citizenship:
Language
Which language do you speak most at home?:
Info
English Proficiency:
Info
Secondary Education
What is your highest completed school level?:
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Year Highest School Completed:
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Are you still enrolled in secondary or senior secondary education?:
Previous qualifications achieved
Have you successfully completed any post-secondary education?:
Disabilities
Do you consider yourself to have a disability, impairment or long-term condition? :
Additional Details
Of the following categories, which best describes your current employment status?:
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Study Reason
Of the following categories, select the one which best describes the main reason you are undertaking this course?:
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