Level 3 APLE Application Form
1. Personal Details
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Contact Email
*
example@example.com
2. Current Employment
Provide information on your current role.
Organisation Name
*
Organisation's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Role
*
Date Started (DD/MM/YYYY)
Responsibilities & Achievements
*
3. Previous Employment
Whether in your current or a different organisation. You can add up to five previous relevant roles; ignore any boxes that you do not need and move onto section 4. when completed.
Organisation Name
Location
Role
Dates (e.g. MM YYYY - MMYYYY)
Responsibilities & Achievements
Additional Employment
Add up to 4 more
Organisation Name
Location
Role
Dates (e.g. MM YYYY - MMYYYY)
Responsibilities & Achievements
Additional Employment
Add up to 3 more
Organisation Name
Location
Role
Dates (e.g. MM YYYY - MMYYYY)
Responsibilities & Achievements
Additional Employment
Add up to 2 more
Organisation Name
Location
Role
Dates (e.g. MM YYYY - MMYYYY)
Responsibilities & Achievements
Additional Employment
Add up to 1 more
Organisation Name
Location
Role
Dates (e.g. MM YYYY - MMYYYY)
Responsibilities & Achievements
4. Education and Training
Provide details on up to five relevant courses. Continue to section 5. once completed.
Course Title
Provider
Award or Qualification
Dates
Additional Education and Training
Add up to 4 more
Course Title
Provider
Award or Qualification
Dates
Additional Education and Training
Add up to 3 more
Course Title
Provider
Award or Qualification
Dates
Additional Education and Training
Add up to 2 more
Course Title
Provider
Award or Qualification
Dates
Additional Education and Training
Add up to 1 more
Course Title
Provider
Award or Qualification
Dates
5. Other Learning Undertaken
Provide details of other relevant learning activity undertaken not covered above (eg less formal, learning-by-doing, self-directed study etc).
Other Learning
6. Reference
List a non-personal reference that may be contacted to support your application.
Reference Name
*
First Name
Last Name
Connection/Relationship
*
Email
*
example@example.com
7. Statement
Provide a statement summarising how your lean knowledge and practical experience meets the Level 3 criteria (no more than 250 words). See Guides 2. and 3. on the My LCS page for more information on this section.
Statement
*
8. Certification Fee Payment
Once the application is received, the invoice will be sent out to you using the details you provide below. A variety of payment options will be available. Note that payment will be requested prior to the review of your application, and once payment has been received, we will begin the review of the application.
Details for the invoice
*
Provide the payer name, address, contact name and email address. Include a PO number if your organisation issues these. If you have already paid using a previously available method, please state the payment details here.
9. Confirmation
I apply for LCS Level 3 certification via the Approved Prior Learning and Experience route. I confirm that the information contained in this application is accurate.
I consent to Lean Competency Services Ltd collecting and storing data from this form
*
Yes
Electronic Signature
*
type your full name/signature to sign
Date
*
-
Day
-
Month
Year
Todays date of submission
Submit
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