Signature & Identification

Please upload your ID and sign for your eligibility check for C3G or CSQ funding

Office Location
What funding you are applying for?
Name Name First Last
Date of Birth Date of Birth / MM / DD YYYY
Privacy and Confidentiality

Civil Safety understands the importance people place on their privacy and personal information. As such, we take your privacy very seriously and comply with the requirements of the National Privacy Principles of the Commonwealth Privacy Act 1988 where they apply to our dealings with you – the student.

I authorise Civil Safety to:

- Collect and release information regarding my enrolment to any government department providing confidentiality is assured;
- Provide a copy of my results for the training connected to this enrolment to my sponsoring employer; and
- Create / verify or update data relating to my USI.
I give Civil Safety permission to use my signature on any documents regarding my enrolment if I miss any upon sign up

I give Civil Safety permission to use my signature on any documents regarding my enrolment if I miss any upon sign up Yes
Draw your signature into the box below.

Draw or Type

Clear

Full Name
Mobile Phone Number
Email
QLD Drivers Licence (Front) - must be in date. Or upload something else showing QLD address

Attach Files

Please upload current QLD Drivers licence Front or upload something else showing QLD address such as bank statement, concession card, utilities bill or government letter.
QLD Drivers Licence (Back)

Attach Files

Please upload current QLD Drivers licence Back or upload something else showing QLD address such as bank statement, concession card, utilities bill or government letter.
Au/NZ Citizenship - ie. Green Medicare Card, Passport or Birth Certificate. Must be in Date

Attach Files

Signature & Identification

Signature & Identification

Privacy and Confidentiality