Client information sheet

Todays Date

YOUR DETAILS
Name
Address
Suburb
Do you live in
public
housing?

Post Code
Yes

No

Date of Birth

Home Phone

Mobile

Email
Gender

Male

Female

Do you
identify
yourself as:

Aboriginal Torres Strait Islander

Country of
Birth
Residency

Have you
completed
any study or
training in
the past?
What was the
qualification(s
)?

Are you doing

any study or
training now?

Australian
Citizen

Permanent
Resident

Other Please Specify:

STUDY
High School
Certificate I
If YES, what
Certificate II
level did you
complete?
Certificate III
Certificate IV

Yes
No

Yes

If YES, what
level are you
undertaking?

No

High
School
Certificate
I
Certificate
II
Certificate
III
Certificate
IV

Diploma
Advanced Diploma
University

Diploma
Advanced
Diploma
University

Part Time
Full Time

What is the
qualification(s
)?
WORK
Are you doing
any paid work
at the
moment?
How do you
want us to

Yes

No

Job Search

If YES, how many hours do you

work per week (on average)?
GOALS
Traineeship

Training (see below)

Client information sheet

help you?
Training:
What type of
training are
you interested
in?
How did you
hear about
us?

English
speaking,
reading and
writing
Care
Worker

Preparing for
work, job
seeking,
personal skills

Internet

Job
Networ
k

Job-specific,
e.g. retail,
hospitality,
childrens
services
Notice
Walked
board
past

General education,
reading, writing,
maths, personal
skills
Friend/
Family/ word
of mouth