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First Name*
Surname*
Date of Birth*
Street Address*
Address Line 2
Suburb*
State*
Postcode*
Phone*
Email*
Are you of Aboriginal or Torres Strait Islander origin?*
- No
- Yes, Aboriginal
- Yes, Torres Strait Islander
- Yes, both Aboriginal and Torres Strait Islander

Applying for work in state*
When are you available to start?
Which apprenticeship are you interested in?
- Licensed Electrician (4 years)
- Licensed Telecommunications Technician (3 years)
- Licensed Lineworker (4 years)
- All
Are you seeking to begin a 1st year electrical/telecommunication apprenticeship
- Yes
- No
Are you currently employed as an Australian Electrical or Telecommunication apprentice?
- Yes
- No
Have you ever been registered as an electrical or telecommunication apprentice?
- Yes
- No
If yes, what year of apprenticeship?
- 1
- 2
- 3
- 4
Have you previously undertaken electrical studies
- Yes
- No
If yes, what is the highest level of study undertaken?
Where did you hear about NECA Electrical Apprenticeships?
Confirmation*
- I confirm that the information given on this form is true and complete.
Name
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UNIQUE STUDENT IDENTIFIER

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