Personal Details

The personal information collected in this form is used to assess eligibility, deliver Indigenous Employment Program (IEP) services, and meet Australian Government reporting, compliance and audit requirements. Submission of this form does not guarantee participation in the program.

Family Name (Surname)

Given Names

Date of birth (dd/mm/yyyy):

GenderFemaleMaleIndeterminate/ Intersex/ UnspecifiedPrefer not to say

Some questions in this form ask for sensitive information. Providing this information helps us determine eligibility and deliver appropriate support. You may choose not to answer certain questions; however, this may affect your eligibility for services.

Do you identify as an Indigenous Australian of Aboriginal and/or Torres Strait Islander descent (please tick all applicable)?AboriginalTorres Strait IslanderNo

Thank you for your interest in the Indigenous Employment Program.

Based on your response, you are not eligible for this program. The IEP is specifically funded to support Aboriginal and/or Torres Strait Islander job seekers.

However, our education and training programs are open to everyone, and we would be happy to help you explore other options that may suit your goals.

Please contact our team on (03) 5023 7612 or email admin@sunraysiarc.com.au for assistance.

Home address

Suburb

State

Postcode

Home Phone

Mobile Phone

Email Address

Is English your first languageYesNo

Do you need an interpreterYesNo

If yes, what language

Indigenous Employment Program

If Other, please specify

Have you previously participated in VTEC, TAEG, EPI or IEPYesNo

If Yes, when did you last participate?0-3 months3-6 months6-9 monthsMore than 9 months

Have you attended an IEP job information session?YesNo

Services Australia / Employment Consultant

Are you registered with a Work Force Australia provideryesnoother employment provider

Employment provider name

Consultant name

Consultant phone

Consultant email

Do you give SRC permission to contact your employment consultant on your behalf?yesno

Do you have a Customer Reference Number (CRN) or Jobseeker ID?

Do you have a Partial Capacity to work or receive a Parenting Payment?yesnonot applicable

If yes please detail

Contact & Emergency Details

Emergency contact name

Relationship to participant

Emergency contact phone

Emergency Contact Street Address

Suburb/Town

State

Postcode

Permission to contact in an emergencyYesNo

Alternate contact name

Alternate contact relationship

Alternate contact phone

Education

What year did you leave school?

Which school did you attend?

Please specify

List any certificates or qualifications you have obtained

Qualification Name

Qualification Level

Year completed/obtained

Resume & Barriers

Do you have a resume?YesNo

Is your resume current?YesNo

Would you like help creating or updating your resume?YesNo

If you would like help building your resume, please tell us about your experience and skills below. Our team will assist you to develop a job-ready resume.

Skills and abilities (for your resume)

How would you rate your literacy and numeracy?GoodAverageRequires assistance

Would you like to be in contact with our Learn Local training team about our pre-accredited training options?YesNo

In what areas could we provide assistance?

Do you have any barriers to employment, disability, impairment or long-term conditions?YesNo

If Other, please describe

How can we provide assistance?

License & Transport

Do you have a current driver licence?YesNo

Are you currently disqualified from driving?YesNo

Length of disqualification?

When did the disqualification Commence? (dd/mm/yyyy):

What type of licence do you have?LearnerProvisional (P1/P2)Full licenceOther

What state was your licence issued in?NSWVic

Do you have your own transport?YesNoOther

If other, please explain

Essential Documents

Do you have a Tax File Number (TFN)?YesNo

Do you need help applying for a TFN?YesNo

Do you have a bank account in your own name?YesNo

Do you need help setting up a bank account?YesNo

Do you have a Medicare card?YesNo

Do you need help getting a Medicare card?YesNo

Do you have a current Health Care Card or Concession Card?YesNo

Do you need help applying for a Health Care or Concession Card?YesNo

Do you have your birth certificate or other primary ID?YesNo

Do you need help getting your birth certificate or ID?YesNo

Checks & Employment Requirements

SRC can assist you to complete applications for employment-related checks and certificates (such as WWCC, Police Check, TFN, birth certificate, and other identification documents). However, SRC cannot pay any associated fees charged by external agencies or services.
All costs for these checks or official document applications must be paid by the participant.

Your employment provider may be able to assist with covering some or all of these costs, depending on your circumstances and their available supports.
We encourage you to speak with your provider to see what financial assistance may be available.

Do you have proof of Aboriginality (if required)?YesNo

Do you need help with proof of Aboriginality?YesNo

Do you have a current Police Check?YesNo

Do you need help applying for a Police Check?YesNo

Do you have a current Working With Children Check (WWCC)?YesNo

Do you need help applying for a Working With Children Check?YesNo

Is there any other document you need help with?YesNo

Please tell us what you need help with.

Activities & Pathway

What activities are you commencing with the IEP? (tick all that apply)EmploymentTrainingMentoringPost-employment support

Are you currently employed?

What date did you start at your position?

Job title / position offered

Employer / business name

Employer contact person

Employer ABN

Employer Phone Number

Employer Email Address

Employer Address

Employer Suburb

Employer Postcode

Employer contact person

What industry is your job in?

What is your employment status?Full timePart time

Are you employed as trainee or apprentice?TraineeshipApprenticeshipNeither

Is this a school-based traineeship (SBT)?YesNo

What certificate level are you completing?Cert ICert IICert IIICert IV

Detail the qualification (if relevant)

School name and location (for SBT students only)

Are you currently looking for a new job or different position?YesNoNot sure

If yes, what kind of job would you like to move into?

If other, please specify

Is this training for a specific industry?YesNo

If other, which industry?

Description of the training or assistance you are starting

Mentoring OptionsHelp settling into a new jobHelp managing work/life balanceSupport with workplace communicationSupport with confidence or motivationSomeone to check in with regularlyNot sure yet

How often would you like your mentor to check in?

Anything else you’d like from mentoring?

What type of post-employment support do you need?Help keeping my jobUnderstanding work expectationsHelp managing workplace issuesAssistance with payslips or timesheetsSupport to increase hoursSupport to transition to a new roleSomeone to check inNot sure yet

If you’d like, tell us more about the support you need

What kind of work are you looking for?

Assistance Options

Interview techniquesYesNo

Cover letter writingYesNo

Online applicationsYesNo

Resume folder / job-ready documentsYesNo

MentoringYesNo

Timesheets / work readinessYesNo

Do you need help with interview or work clothing?YesNo

What types of work are you interested in?Full-timePart-timeTraineeshipApprenticeship

If traineeship or apprenticeship, what qualification level?Certificate ICertificate IICertificate IIICertificate IV

Job preference and areas where SRC can assist

Please upload identification (e.g. licence, Medicare card, birth certificate)

No file chosen

Upload your resume (optional)

No file chosen

Do you give permission for SRC to share your information with partner organisations to assist with training or employment?YesNo

Without permission to share your information, SRC may be limited in the assistance we can provide. A staff member will discuss this with you.

By submitting this form, you acknowledge that you have read our Privacy Policy.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Policy.

I confirm all information I have provided is true and correctYesNo

Please type your full name

Date (dd/mm/yyyy):

iep intake form

Sunraysia Regional Consulting