Please fill in the form to join us as Third Party Provider! CommentsThis field is for validation purposes and should be left unchanged.Legal Name(Required)Trading Name(Required)ABN(Required)ACN(Required)RTO Number (if an existing RTO)Contact DetailsName(Required)Phone Number(Required)Email(Required) Location(Required)Signature(Required)I certify that the information I have supplied is accurate and I authorise H & A Training or its agents to make any necessary enquiries regarding becoming a Partnership. If engaged by H & A Training, I agree to follow their instructions and systems to make any/all payments promptly and abide by the MOU signed by the partnership. I understand that failure to follow H & A Training procedures and manuals may result in forfeiture of my Partnership/Trainer status Your NameYour NameYour NameYour NameTrainer DetailsGiven Name(Required)Surname(Required)Date of Birth(Required) Phone Number(Required)Email(Required) Address(Required) Street Address Town/Suburb State Postcode Current Employer and Position(Required)Name and Phone Number of a Professional Referee(Required)Working with Children Check Number (or State Equivalent)(Required)Working with Children Check (or State Equivalent) Expiry Date(Required) Have you ever: (Please tick those that apply)(Required) Been convicted of an offence against a law of the commonwealth or of a state or territory of Australia or a parliament of another country? Been disqualified from managing corporations under part 2D.6 of the Corporations Act 2001(Cth)? Been an executive officer of high managerial agent of an organisation at a time when its actions resulted in it being found to have breached a condition imposed on its registration or resulted in it registration being cancelled or suspended in part or in full: I. As a registered training organisation or; II. As a higher education provider or; III. As a registered provider under the Education Services for Overseas Students Act 2000 (Cth)? Been involved in the delivery of courses or other services by a registered training organisation at a time when its actions resulted in it being the subject of regulatory action? Been involved in the delivery of courses or other services for an organisation operating under an arrangement with registered training organisation when the registered training organisation was the subject of regulatory action? Provided false or misleading information or made a false or misleading statement to: I. A regulatory authority (or delegate) of a registered training organisation; or II. A regulatory authority (or delegate) of higher education providers; or III. A regulatory authority (or delegate) of registered providers under the Education Services for Overseas Students Act 2000 (Cth) Considered there to be any doubt about whether the public is likely to have confidence in your ability to provide, assess or deliver recognised qualifications? NO to all questions Please Provide Details for Q1(Required)Please Provide Details for Q2(Required)Please Provide Details for Q3(Required)Please Provide Details for Q4(Required)Please Provide Details for Q5(Required)Please Provide Details for Q6(Required)Please Provide Details for Q7(Required)Trainer CredentialsVerification Consent FormClick here or go to "Forms" on our website to download our Verification Consent Form. Once completed and signed, please upload it hereVerification Consent Form(Required)Max. file size: 100 MB. Training and Assessment Competence(Required)Training and Assessment Qualifications e.g. TAE40122 Certificate IV in Training and AssessmentIssuing RTOIssue Date Attach Training and Assessment Competence Certificates including Transcript showing all units with outcomes(Required) Drop files here or Select files Max. file size: 100 MB. Vocational Competence(Required)Vocational Qualifications e.g. HLTAID011 Provide First AidIssuing RTOIssue Date Attach Vocational Competence Certificates(Required) Drop files here or Select files Max. file size: 100 MB. Industry Skills, Knowledge and Experience(Required)Please note that being a Trainer/Assessor of CPR/First Aid is not classed as industry experience Description e.g. First Aid Officer, Nurse, Paramedic, etc.Company Attach Evidence of Industry Skills(Required)Please provide evidence e.g. Certificate of Registration, verifying letter from employer, etc. Multiple files may be added if required Drop files here or Select files Max. file size: 100 MB. Training ExperienceCourses DeliveredCompany Trainer Declaration(Required)I declare that the information provided on this Trainer/Assessor application is true and correct. I have provided certified copies of all qualifications, statements of attainment, transcripts and records of results that have been listed on this application. I give permission for H & A Training to verify the validity of my certifications in accordance with the Standards for Registered Training Organisation’s 2025.Your NameYour NameYour NameYour NameVerification
