Student Registration form Certificate IV in Building and Construction(Building) CPC40110 (Electronically Based) Master Builders Membership Are you a member of Master Builders? Yes No If yes, what is your membership number: If no, are you interested in being contacted to discuss the benefits of Master Builder's membership? Yes No Personal Details Title Mr Mrs Miss Ms First given name Surname or Family name Other given names Date of Birth (Day/Month/Year) / / Postal address Home address (if different from postal address) Suburb or town Suburb or town State Post code State Post code Home telephone: Work telephone: Mobile: Fax E-mail: Copy of Photo ID/ Current Induction Card > Please attach a verified high quality colour copy of your Photo ID ( Current driver license or Passport) > Please attach a verified high quality colour copy of Current Induction Card Paticipant Initials:. V1.0 16052012 1/11
Current Employment Are you employed full time by someone else? Are you employed part time or casual by someone else? Are you employed unpaid family worker? Master Builders Association of NSW Pty Ltd Are you unemployed - looking for full time work? Are you an apprentice? Yr1 Yr2 Yr3 Yr4 Are you unemployed - looking for part time work? Are you an employer - someone who employs people? Are you not employed - not looking for work? Are you self employed? Please write down current employer details if applicable. Trading name: Address: Suburb or town: State: Post code: Contact Name/Position: Contact number: E-mail: Employment History How many years have you been working in building and construction industry? years and months Did this include an apprenticeship? Yes No Trade of apprenticeship Please list your employment history (including self employment) in the building and construction industry. Period Full/part Company name Description From To time Professional Referees (relevant to work situation) Name: Organisation: Name: Organisation: Contractor Builder license No. : Contractor Builder license No. : Position: Contact number: E-mail: Position: Contact number: E-mail: Paticipant Initials:. V1.0 16052012 2/11
Education / Training Master Builders Association of NSW Pty Ltd What is your highest completed school level? Year 12 Year 11 Year 10 Year 9 or below Which year did you complete this school level? Are you still attending high school? Yes No Have you successfully completed any of the following qualifications? Bachelor degree or higher degree Advanced diploma or associate degree Diploma or associate diploma Cert IV or Advance Certificate Certificate III or trade certificate Certificate II Certificate I What was the name of the qualification(s)? Please specify: Certificates other than above, please specify: Are you currently enrolled in any accredited course? Please specify: How did you hear about this Master Builders training course? MBA E-mails MBA Magazine MBA News Brief MBA divisional meeting Google search Radio Trade shows Newspaper/Magazine Information Sessions Yellow Pages Word of Mouth MBA BBQ What is your reason for undertaking this Master Builders training course? To develop my existing business To gain employment Upgrade my qualifications To try for a different career pathway Requirement for my employment It is a licensing requirement For career, personal development To start my own business Other reasons: Background Were you born in Australia? Yes No If no, which country were you born: Are you aboriginal or Torres strait islander origin? Yes No Are you permanent resident or citizen of Australia? Yes No Do you speak a language other than English at home? Yes No If yes, please specify what language: How well do you speak English? Very well Well Not well Not at all Is English language assistance required? Yes No Do you consider yourself to have a disability, impairment or long term condition? Yes No If yes, please indicate the area of disability, impairment or long term condition: Hearing/Deaf Vision Medical Condition Intellectual Learning physical Mental illness Other, please specify: If you have any other special need, please specify: Proof of evidence establishing fee exemption (Please attach if applicable) Paticipant Initials:. V1.0 16052012 3/11
Pathways for Certificate IV in Building and Construction (Building) CPC40110 (Electronically Based) Master Builders Association of NSW Pty Ltd Recognition of Prior Learning (Electronically Based) - Assessment of current competencies by participant demonstrating and providing evidence through previous learning and onsite experience. This pathway has been specifically designed for those individuals operating within the building and construction industry who can demonstrate extensive management and supervisory experience in the residential building sector. Important information and declaration 1. I declare that the information I have given is true and correct. 2. I understand and consent to the release of my personal information for the following purposes. that: (a) The Master Builders Association Of NSW Pty Ltd, will collect my personal information for the purposes of training and assessment, reporting, administration and evaluation of the Program; (b) The Master Builders Association Of NSW Pty Ltd, may disclose my personal information to the following: i. Department of Industry, Innovation, Science, Research and Tertiary Education(DIISRTE); ii. The Department of Education and Community Services NSW or other relevant state authority. iii. Construction and Property Services Industry Skills Council (CPSISC); and iv. The contractors or agents of any of the above organisations. (c) The purposes of the above disclosure may include: i. Reporting, administration, and evaluation of the Program; ii. Verifying or reporting on my progress in the Program; and (d) CPSISC, DIISRTE and DEC or relevant state authority may disclose my personal information to another party without my consent where authorised 3. I have accessed and read through the online Participant Handbook and confirm that I have read the policies and procedures contained within the Participant Han 4. I understand that : Cert IV qualification may not, on its own, entitle me to apply for a Contractor's licence. Upon successful completion on this qualification you will be issued with the relevant certificate and transcript. The licensing body for the state will determine the issue of the contractor's licence. * For licensing requirements from the Fair Trading NSW, visit the website www.fairtrading.nsw.gov.au - Licence classes and qualifications 5. The cost of the training process has been fully explained. 6. I am aware that if the training and assessments are not completed within 9 months, a Statement of Attainment will be issued for the completion of units of competency achieved only. 7. I am aware that after face to face training, all assessment tasks must be completed within 21 days unless an Assessment Extension Request has been lodged. Following information and declaration is only applicable for participants applying for Recognition of Prior Learning. 8. I am aware that any skills gap training identified by the assessor is to be paid by the participant. 9. I understand that additional evidence is to be collected and/ or additional training needs to be undertaken. 10. I am aware that any decision made by the assessor can be appealed. 11. I am aware of the requirements relating to workplace evidence collection and have obtained agreement for support from my relevant workplace manager or supervisor. 12. I am aware that there will be a validation upon completion. Printed Name: Signature Date day month year / / Paticipant Initials:. V1.0 16052012 4/11
How to send back Please initial every page and return this completed form(including office use only page) to: Pointsbuild Pty Ltd, for the attention of the Cert IV Co-ordinator by fax: (02) 6382 7901 e-mail: info@pointsbuild.com.au PO BOX 5122, Sydney, NSW, 2001 For more information contact the Master Builders Training Department on (02) 8586 3555 or e-mail info@pointsbuild.com.au Check List Before sending back ( Important) Please check whether you completed and attached following documents before sending back to us. I have filled out all information as required and put initials on every page I have attached a certified colour copy of Photo ID ( Driver licence or Passport) I have attached a certified colour copy of Current Induction Card I have attached proof of evidence establishing fee exemption (if applicable) Paticipant Initials:. V1.0 16052012 5/11
Date Competency Achieved / Assessor Signature Competent Not Yet Competent Photos Previous Qualifications / CT Third Party Practical Questions Skills Gap Training Pathway: Classroom/RPL FOR OFFICE USE ONLY Master Builders Association of NSW Pty Ltd 16 Units of competency are required for award of this qualification: 13 compulsory units Training and Assessment Proposal/Plan for Certificate IV in Building and Construction (Building) CPC40110 3 pre selected elective units for licensing purpose ASSESSMENT TABLE ( TO BE COMPLETED BY ASSESSOR) CORE UNITS (Core competency units cannot be substituted and are compulsory) Unit Code Unit Title CPCCBC4001A CPCCBC4002A CPCCBC4003A CPCCBC4004A CPCCBC4005A CPCCBC4006B CPCCBC4007A CPCCBC4008B CPCCBC4009B CPCCBC4010B CPCCBC4011B CPCCBC4012A Apply building codes and standards to the construction process for low rise building projects Manage occupational health and safety in the building and construction workplace Select and prepare a construction contract Identify and produce estimated costs for building and construction projects Produce labour and material schedules for ordering Select, procure and store construction materials for low rise projects Plan building or construction work Conduct on-site supervision of building and construction projects Apply legal requirements to building and construction projects Apply structural principles to residential low rise constructions Apply structural principles to commercial low rise constructions Read and interpret plans and specifications BSBSMB406A Manage small business finances Paticipant Initials:. V1.0 16052012 6/11
Date Competency Achieved / Assessor Signature Competent Not Yet Competent Photos Previous Qualifications / CT Third Party Practical Questions Skills Gap Training Pathway: Classroom/RPL Master Builders Association of NSW Pty Ltd Unit Code Unit Title CPCCBC4018A CPCCBC4024A Apply site survey and set-out procedures to building and construction projects Resolve business disputes CPCCBC4026A Arrange building applications and approvals I agree and accept the training proposal/plan prepared by Master Builders Association of NSW and undertake to complete the proposed actions and pay the cost as detailed in the training proposal. Certification at Commencement Assessor/Coordinator Printed Name: Signature: Date: Participant Printed Name: Signature: Date: Employer (if applicable) Company Name: Printed Name: Signature: Date: Certification at Completion Assessor/Coordinator Printed Name: Signature: Date: Participant Printed Name: Signature: Date: Employer (if applicable) Company Name: Printed Name: Signature: Date: Paticipant Initials:. V1.0 16052012 7/11
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ontained within the Participant Handbook. Paticipant Initials:. V1.0 16052012 11/11