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Application Form

To apply for a workshop either download the application form and forward it to the Staff Development or fill in the following on-line form and submit.

On-line Application Form

Note: Please ensure that you have read and understood the workshop outline and completed the required prerequisites as detailed on the workshop page. Please contact Staff Development if you have questions about the workshop you have registered to attend.

*All fields to be completed

Title:
Name:	First Name		Family Name
Staff Id No:
Gender :	Male Female
Staff level:	Academic		Professional
Position:
Department:			Faculty/Division:
Contact:	Phone/Extension		Mobile
Email:
Campus/Site:	Clayton Caulfield Peninsula Gippsland Berwick Parkville Other
	*For non Monash* applicants only:**
Work address:
Email:
Program Details: Select each program,enter the preferred date and location.
CPR Refresher CPR Refresher dates Mental Health First Aid Mental Health First Aid dates First Aid level 2 First Aid level 2 dates First Aid 2 Mixed Mode First Aid Mixed Mode dates Remote Area First Aid Remote Area First Aid First Aid Management of Anaphylaxis First Aid Management of Anaphylaxis Health & Safety Representative (HSR) HSR dates HSR Refresher Training HSR refresher dates Biosafety Module 1 Biosafety Module 1 dates Biosafety Module 2 Biosafety Module 2 dates Gas Cyclinder Safety training Gas Cyclinder Safety training dates Laser Safety Officer Training Laser Safety Officer dates Laser Safety Training Laser Safety dates Radiation training for Synchrotron Users Radiation training for Synchrotron Users RSO training RSO training dates RSO Refresher Training RSO Refresher Training dates			Breathing Apparatus Breathing Apparatus dates Cryogenics Cryogenics dates Chemwatch Chemwatch Dates Essential OHS Essential OHS dates Ergonomics & Manual Handling Ergonomics & Manual Handling dates Emergency Warden training & Fire Safety at Work Emergency Warden training & Fire Safety at Work dates Fire Safety & Extinguisher training Fire Safety & Extinguisher training Hazard & Incident Investigation Methods Hazard & Incident Investigation Methods dates Hazardous Substances & Dangerous Goods Awareness Hazardous Substances & Dangerous Goods Awareness dates Hazardous Substances & Dangerous Goods (Cert IV) Hazardous Substances & Dangerous Goods dates Hydrofluoric Acid Safety Training Hydrofluoric Acid Saftey training dates OHS Risk Management (Cert IV) OHS Risk Management dates Risk Management Risk Management dates Workplace Safety Inspections Workplace safety Inspection dates
Is this an identified training and development need ?
Yes No
Have you completed the workshop prerequisites?
Yes No
Please check here for Important Information for all Staff Development and OH&S workshops
Payment Options:
Payment Option 1.	Please provide cost centre & fund code
	Account Code	Cost Centre		Fund
	734061
Payment Option 2.	Cheque Cheque made out to Monash University and forwarded to Staff Development
Payment Option 3.	Invoice Debtors invoice (For departments not on SAP)
I have my supervisor's approval to attend this program

The Information collected on this form is collected for the primary purpose of processing your application to attend a Monash University training course or event. Other purposes of collection include communicating with you, program administration, reporting and de-indentified statistical analyses. The information may also be disclosed to a third party training provider (if relevant) for course delivery purposes. If you choose not to provide all the information requested on this form, it may not be possible for you to fulfil (or meet) your training requirements. You have a right to access personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal information or inquire abut the handling of your personal information, please contact the University Privacy Officer on 9902 9589