Career Guidance & Support Advance your career If you’re aged between 45 – 70, employed or recently unemployed (less than 9 months) and not receiving Australian Government employment assistance, we can help. Home » Skills Checkpoint for Older Workers Skills Checkpoint for Older Workers Program Information on how to fill in this form here (.pdf file).1. Your personal detailsGender:*FemaleMaleIndeterminate/Intersex/UnspecifiedTitle:MrsMissMsTitle:Mr.Title:MxLegal first name:*Legal middle name:*Legal family name:*Preferred name:Residential address:*Suburb:*State / Territory:*Postcode:*Home phone:Mobile phone:*Email* 2. Eligibility Questions To be eligible, you must be: aged 45 to 70 years old at the date this form is lodged, AND an Australian Citizen or permanent resident, AND either employed and at risk of entering the income support system, OR unemployed for less than nine consecutive months and not registered for assistance through an Australian Government employment services program. a. Your ageAge at time of application:*Please enter a number from 45 to 70.Date of birth:* Date Format: DD slash MM slash YYYY b. Your citizenship and residencyAre you an Australian Citizen or permanent resident?*YesNo (If No, you are not eligible)c. Previous participationHave you previously had a Skills Checkpoint assessment?*Yes (If Yes, you are not eligible)Nod. Your employment details(i) Are you currently employed?*Yes (Go to section 3. Proof of identity)No(ii) If you are unemployed:Have you been unemployed for more than nine consecutive months?*Yes (If Yes, you are not eligible)NoDate of your last paid work:* Date Format: DD slash MM slash YYYY Are you registered for assistance through an Australian Government employment services program? E.g. jobactive, Disability Employment Service, Community Development Programme.Yes (If Yes, you are not eligible)No3. Proof of identityTo verify your identity, you must show the Skills Checkpoint Provider ONE document from Group A or two documents from Group B as detailed below. All documents must be original or a certified copy. Group A (Note: only one document is required from Group A) Drivers licence (please record state/territory and licence number)*Drivers license Upload*Accepted file types: jpg, gif, png, pdf, doc, docx.OR Current Australian passport (please record number)*Current Australian Passport Upload*Accepted file types: jpg, gif, png, pdf, doc, docx.OR other form of photo identification from a government department or agency (please specify)*Other form of photo identification from a government department or agency upload*Accepted file types: jpg, gif, png, pdf, doc, docx.Group B (Note: two documents are required from Group B only if no documents were provided from Group A)Alternative documentation including:* ATM/credit cards showing name and signature Bank statement showing your name and address Medicare card Birth certificate or birth certificate extract Certificate of Australian citizenship Motor vehicle registration papers with current address Australian marriage certificate Documents showing registration of a change of name Divorce papers Trade certificate Insurance renewal documents showing current address Account numbers are not copied or recorded.Details of alternative documentation shown to your Skills Checkpoint Provider:Document #1 Upload*Accepted file types: pdf.Document #2 Upload*Accepted file types: pdf.If you cannot provide information in either Group A or Group B, talk to your Skills Checkpoint Provider about what other forms of documentation are sufficient to prove your identity. For example, documentation that shows your name and address (postal or residential) can be used to confirm your identity. This could include rates notices, mobile phone or other bills. Alternatively, other forms of documentation that contain your name, such as letters of reference, payslips from previous employment, library and other club memberships or education certificates may be used. Where you do not have sufficient documentation, the Department of Human Services may be able to assist.Details of alternative documentation shown to your Skills Checkpoint Provider:4. Employment informationIf you are employed, are you currently working 15 hours or more per week?If you are employed, are you currently working 15 hours or more per week?*YesNoIf you are employed, are you currently working full-time or part-time?If you are employed, are you currently working full-time or part-time?Full-timePart-timeIf you are employed, what type of work do you do? If you are unemployed, what was your previous type of work? Please select from the list below.If you are employed, what type of work do you do? If you are unemployed, what was your previous type of work? Please select from the list below.* Accounting Administration & Office Support Agriculture, Animals & Conservation Architecture & Design Banking & Financial Services Communications, Advertising, Arts & Media Community Services Construction Customer Service & Call Centre Defence & Protective Services Education & Training Engineering Executive & General Management Health & Medical Hospitality & Tourism Human Resources & Recruitment Information & Communication Technology (ICT) Insurance & Superannuation Legal Manufacturing Mining & Energy Real Estate & Property Retail Sales Science Sport & Recreation Trades & Services Transport & Logistics If you are employed, what type of work do you do? If you are unemployed, what was your previous type of work? Please select from the list below.AccountingAdministration & Office SupportAgriculture, Animals & ConservationArchitecture & DesignBanking & Financial ServicesCommunications, Advertising, Arts & MediaCommunity ServicesConstructionCustomer Service & Call CentreDefence & Protective ServicesEducation & TrainingEngineeringExecutive & General ManagementHealth & MedicalHospitality & TourismHuman Resources & RecruitmentInformation & Communication Technology (ICT)Insurance & SuperannuationLegalManufacturingMining & EnergyReal Estate & PropertyRetailSalesScienceSport & RecreationTrades & ServicesTransport & LogisticsIf you are employed, what type of industry do you work in? If you are unemployed, what type of industry did you previously work in? Please select from the list below.If you are employed, what type of industry do you work in? If you are unemployed, what type of industry did you previously work in? Please select from the list below.*Accommodation, Cafes and RestaurantsAgriculture, Forestry and FishingCommunication ServicesConstructionCultural and Recreational ServicesEducationElectricity, Gas and Water SupplyFinance and InsuranceGovernment Administration and DefenceHealth and Community ServicesManufacturingMiningPersonal and Other ServicesProfessional ServicesProperty and Business ServicesRetail TradeTourismTransport and StorageWholesale TradeOtherIf you are employed, what type of industry do you work in? If you are unemployed, what type of industry did you previously work in? Please select from the list below. Accommodation, Cafes and Restaurants Agriculture, Forestry and Fishing Communication Services Construction Cultural and Recreational Services Education Electricity, Gas and Water Supply Finance and Insurance Government Administration and Defence Health and Community Services Manufacturing Mining Personal and Other Services Professional Services Property and Business Services Retail Trade Tourism Transport and Storage Wholesale Trade Other If Other5. Optional questionsCountry of birth:Do you identify as an Aboriginal or Torres Strait Islander? Yes No Prefer not to say Do you have any disabilities or medical conditions that may affect the type of work and training you can do? Yes No Prefer not to say If yes, please provide details of any additional support that you may need.*6. Education levelWhat is your Highest Education Level? (please select from the list below)What is your Highest Education Level?*Year 10 or equivalentYear 12 or equivalentVocational Education and Training Certificate I or other industry-specific licence or ticketOther non-trade Vocational Education and Training Certificates II, III or IVTradesperson’s qualificationDiploma, Advanced Diploma, Associate Degree or equivalentBachelor Degree or equivalentVocational Graduate Certificate, Graduate Certificate or equivalentVocational Graduate Diploma, Graduate Diploma or equivalentOther/unknownWhat is your Highest Education Level? Year 10 or equivalent Year 12 or equivalent Vocational Education and Training Certificate I or other industry-specific licence or ticket Other non-trade Vocational Education and Training Certificates II, III or IV Tradesperson’s qualification Diploma, Advanced Diploma, Associate Degree or equivalent Bachelor Degree or equivalent Vocational Graduate Certificate, Graduate Certificate or equivalent Vocational Graduate Diploma, Graduate Diploma or equivalent Other/unknown Specify Other/unknown7. Declaration by applicantI have been informed about the Program including how the Skills Checkpoint advisor will assist me and what I need to do. I have provided true and correct information. I am aware that it is a serious offence to provide false or misleading information. I acknowledge I have read, or have had read to me, the above privacy statement and I consent to my personal information, including sensitive information being collected, used, and disclosed as set out in that privacy statement.Signature*Date* Date Format: DD slash MM slash YYYY Applicant’s printed name*Optional: any other documents to upload (e.g. resume)?Accepted file types: jpg, gif, png, pdf, doc, docx.8. Declaration by ProviderIs the person eligible for the Program?YesNoHas the person’s identity been confirmed?YesNoIs there a place available for this person, this financial year?YesNoBy signing below, I declare that: The information about the applicant, as entered on this form and, where relevant in the Department’s IT Systems, is true and correct to the best of my knowledge.Provider’s signatureAccepted file types: jpg, png.Date Date Format: DD slash MM slash YYYY Provider’s printed name