Expression of Interest

Please note eligibility requirements are required to be met for some courses and funded programs, the information provided in this form will help us determine your eligibility.

PHARMACY DETAILS

Pharmacy Name*

Pharmacy Contact Person Name*

Pharmacy Phone Number*

Pharmacy Email*

Who should be contacted regarding this enquiry?

STUDENT DETAILS

This expression of interest is on behalf of:

Australian Citizen

New Zealand Citizen

Australian Permanent Resident

Temporary visa with work and study rights and on the pathway to Australian Permanent Residency

Other

Learner Name*

Learner Previously Known Name/s*

Learner Phone Number*

Learner Email*

Date of Birth*

Position*

Pharmacy assistant

Retail manager

Dispensary assistant

Select the course/s of interest*

SIRCIND002 Support the Supply of Pharmacy Medicines & Pharmacist Only Medicines

SIR20116 Certificate II in Community Pharmacy

SIR30116 Certificate III in Community Pharmacy

SIR40116 Certificate IV in Community Pharmacy

SIR40216 Certificate in Community Pharmacy Dispensary

Dispensary Assistant Courses

QCPP Refresher Training

Employment commencement date with current employer*

Employment status*

Full Time

Part time

Casual

Is the learner currently enrolled into or have already completed any other certificate, diploma or tertiary qualifications?*

Yes

If yes, please list the qualifications below

TRAINEESHIPS (where Federal Government incentives may apply)

I authorise The Pharmacy Guild of Australia (Qld Branch) to contact an Australian Apprenticeship Support Network (AASN) on my behalf to arrange a traineeship sign up for the following staff member:*

Yes

If you have a preferred AASN please state here:

Please note:
* must be a full-time or part-time staff member. Casual staff cannot be employed under a traineeship.
** This form is for Queensland and Tasmanian residents only - RTO 0452

Privacy Notice: By completing this form I acknowledge that the Pharmacy Guild of Australia, Queensland and Tasmanian Branch will record my personal information on their database and may send me marketing material about their products, services and events, either directly or via their subsidiary companies. I understand that I do not have to complete this form and can withdraw my consent at any time through providing written notification of this to the Pharmacy Guild of Australia. RTO 0452