Application – Ag Challenge

Course*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Mobile Phone*

Phone

Date of birth*

Alternate contact name*

First Last

Relationship to alternate contact*

Alternate contact phone*

What was your main activity three months before this application?*

What are you currently doing?*

Are you enrolled with WINZ?*

Yes
No

Which benefit do you receive?*

Have you had any experience relative to this course? If YES, for how long and with whom?*

Do you have any medical conditions or disabilities which may affect your learning or work experience, and / or do you suffer from any allergies? (i.e. bee stings, asthma etc.)*

Do you have any specific cultural, sporting or religious needs which may affect your learning or work experience? List them if YES.*

Do you have any past criminal history?*

Yes
No

The failure to disclose ANY criminal history could result in your enrolment being terminated, pending the result of the Ministry of Justice check, if it finds that you have misrepresented yourself during this interview; with “no refund” of fees where fees have been paid.

Details of criminal history*

Do you have any current or upcoming court imposed obligations, e.g. PD, community service etc? If YES please provide details.*

Do you hold a current drivers licence? If so, which licence?*

Do you have access to a vehicle that you can use to get to course and is it reliable enough to use for work experience?*

Do you have access to a computer/ laptop/ tablet you could use for your studies?*

What are your interests and hobbies?*

Farming Courses Only: For work experience, would you rather live on farm or travel daily?

How did you hear about this course?*

Is there any other information you think is relevant to your application?*

Disclosure Statement

In submitting this application form I acknowledge that final acceptance is at the discretion of AGC Training Ltd and is subject to the following:

Eligibility check. Some programmes and courses are subject to entry criteria. We will contact you to discuss these on receipt of your application.
Acceptable outcome of a Ministry of Justice (MOJ) check.
Enrolment will not be accepted without a Birth Certificate / Passport.
Drivers Licence or other suitable photo ID is also required.
If you are aged 15 1/2, enrolment will not be accepted without a school exemption.
AGC Training programmes are only available to Domestic students. I confirm that I am a NZ / AUS citizen or Permanent Resident.
I confirm that I have read and understood the Student Handbook. (Please click the following link to view on the AGC Training website AGC Training 2020 Student Handbook)

Please complete all questions to the best of your ability. Please contact the main office (0800 348 8215 or info@agchallenge.co.nz) if you have any questions regarding this application form or programme structure.

Agreement*

I have read and agree to the disclosure statement.