Your Information *This is a required field. First Name* Last Name* Phone Number* Email* Date of Birth* Address* Suburb* State* Postcode* Are you of Aboriginal or Torres Strait Islander origin?* Yes, AboriginalYes, Torres Strait IslanderYes, Aboriginal and Torres Strait IslanderNo, neither Aboriginal nor Torres Strait Islander Have you previously received NEIS or Self-employment Assistance mentoring in the past 12 months?* NoYes Which of these options best describes your current employment status?* Part-Time EmployeeSelf-Employed - Not Employing othersEnrolled in Full - Time StudyEnrolled in Part-Time StudyEmployed - Unpaid worker in a family businessUnemployed - seeking Full-Time workUnemployed - Seeking Part-Time work Which if any of the following Centrelink payments are you receiving?* Job SeekerParenting Payment SingleParenting Payment PartneredDisability Support PensionOtherNone Your Jobseeker ID Centrelink Reference Number (if known) Dedicated Employment services provider (if relevant) Are you an UNDISCHARGED Bankrupt?* NoYes Do you have any criminal convictions?* A requirement of the program is to obtain business insurance when you start your business. If you have been convicted of a criminal offence within the past 5 years, you may face a problem obtaining insurance for your business. Have you been convicted of a criminal offence in the previous five years? NoYes Which statement best describes you?* Small Business Coaching supports individuals to start their own small business as well as those who are already operating their own business. Applying as a current business ownerIndividual looking to start a business Do you have an existing business?* NoYes If you answered yes above, is your business more than six months old? NoYes If you answered yes above, what was your business’ net profit in the last financial quarter? Brief description of your proposed / current business* Why do you wish to pursue this as a business?* Have you undertaken any market research?* NoYes Do you have the equipment/facilities required to start/run this business?* NoYes Are you thinking of starting your business with a business partner?* NoYes What education, skills & experience do you have that can be used in your business?* The training provided is practical and small business focussed. It will build your knowledge and awareness of areas such as sales, marketing, financial management and business planning. Are you seeking to participate in business training to start your small business journey? Small Business Coaching supports the development and growth of your new small business. The core of the program is business training to successfully launch, manage and grow your business. NoYes How soon are you hoping to get started?* Right away1 month from application2 months from application3 months from applicationMore than 3 months from application Do you have any questions for us, or messages to consider when assessing your application? Lastly, for our own marketing purposes, could you please tell us how you heard about the Self Employment Assistance Program?* Workforce Australia ProviderWorkforce Australia OnlineWord of MouthTraining Alliance Group WebsiteFacebookLinkedInInstagramGoogleOther I certify that the information that I have supplied on this form is complete and correct to the best of my knowledge and I acknowledge that false information may lead to refusal, suspension or termination from the program* Yes Ensure all fields are complete before clicking submit Upon submitting this online registration form you will receive a call from our team (within 2 business days), Please indicate in the field below the best day and time (Monday-Friday, 9am-5pm) for them to call you. If you miss our call, please contact us back on 1300 436 756.