RIDER DEVELOPMENT SCREENING DAY 2015
Racing Victoria is conducting a Rider Development Screening Day (Screening Day) to be
held on Sunday 19 April 2015.
People wishing to attend must complete and return this Expression of Interest (EoI) form by
Thursday 2 April 2015.
Details of where this EoI is to be submitted are provided at the end of this form.
The Screening Day provides the opportunity for riders to extend their theoretical riding
knowledge and skills and provide some practical riding work on a mechanical horse.
Key areas that will be covered at the Screening Day are the advanced understanding of the
Rules of Racing, race riding criteria, riding tactics, horse analysis skills as they apply to track
work and jump outs and practical work on the mechanical horse.
The Screening Day is being held to provide Racing Victoria with the opportunity to assess
the theoretical knowledge and practical riding skills of each participant and to provide advice
about the most appropriate pathway for development. This pathway may include identifying
areas of further development such as practical training and/or recommending the completion
of competency training units with the Racing Industry Skills Centre.
Limited places are available to attend the Screening Day.
Please note: attendance at the Rider Development Screening Day does not guarantee
the issue or approval of any registration, license or permit upon application to Racing
Victoria nor does it serve as a precursor to acceptance into Racing Victoria’s
Apprentice Jockey Training Program.
DETAILS:
DATE
Sunday 19 April
TIME
10am to 4pm
LOCATION
Racing Victoria, 400 Epsom Road, Flemington VIC 3031
inc 1hr lunch break
Please note that Racing Victoria reserves the right to cancel or reschedule the
Screening Day in its absolute discretion at any time, for any reason whatsoever.
CONDITIONS

Applications close Thursday 2 April 2015.

Limited places are available. Applicants who have successfully gained a place to
attend the Screening Day after their EoIs have been assessed by Racing Victoria will
be notified in the week commencing 7 April 2015.

Racing Victoria may accept or refuse an application in its absolute discretion and will
not enter into any correspondence whatsoever in respect of its decision.

The successful applicants must pay an enrolment fee of $100 to Racing Victoria by
15 April 2015. Attendance will not be secured until payment is received in full.
Rider Development Screening Day EOI 2015
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RACING VICTORIA LIMITED
ACN 096 917 930
Workforce Development
400 Epsom Road
Flemington VIC 3031, Australia
Telephone: (+61 3) 9258 4204
Facsimile: (+61 3) 9258 4685
Email: [email protected]
EXPRESSION OF INTEREST
Rider Development Screening Day
Section 1: Personal Information
Family Name:
D.O.B:
Given Name(s):
Gender (please tick):
Preferred Name:
*Age:
F
Height:
M
Weight:
*Age as at 1 June 2015.
Residential Address:
Suburb
Postal Address:
Post Code:
Post Code:
(only if differs from above):
Contact Telephone:
Mobile:
Email Address:
Section 2: Language and Cultural Diversity
Country of Birth:
Australia
Other:
Please specify:
Are you an Australian Citizen or Permanent Resident of Australia?
Yes:
No:
Are you of Aboriginal or Torres Strait Islander origin?
Yes:
No:
Language spoken at home:
English:
Other:
Please specify:
Well
Very well
Yes:
No:
Or a holder of a permanent visa of Australia?
Yes:
No:
Or a holder of a Special Category Visa (sub-class 444)?
Yes:
No:
Or a Temporary Protection Visa Holder?
Yes:
No:
How well do you speak English?
Not at all
Not well
Section 3: Citizenship
Are you an Australian Citizen?
If no, please continue.
Or an East Timorese Asylum Seeker?
Yes:
No:
Please provide a copy of Birth Certificate OR Green Medicare Card & Proof of Age (Drivers
Attached
Licence)
Rider Development Screening Day EOI 2015
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Section 4: Concession Status and Job Seeker Referral (JSA)
I have a Concession Card.
Yes:
No:
If yes, a copy of current concession document must be attached if a concession Tuition Fee
Attached
is required. Eg. Copy of Health Care Card
Do you have a Job Seeker (JSA) referral?
Yes:
No:
The original Job Seeker Referral form must be attached if Yes is selected.
Attached
Section 5: Parent / Guardian Details (if applicant is under 18 years of age)
Name (s):
Residential Address:
Suburb
Post Code:
Contact Telephone:
Mobile:
Email Address:
Section 6: Emergency Contact (in an emergency, the person to be contacted on your behalf)
Name:
Relationship:
Address:
Home:
Work:
Mobile:
Section 7: Racing Victoria Registration
Are you currently registered with Racing Victoria as a stable employee:
Yes – please provide registration number ____________________
No
Section 8: Education Details
Highest completed school level:
Are you currently attending school?
Yes
No
If yes, please provide school name, address
and your school level :
If no, year last attended and please provide
school name, address and highest school
level completed.
Section 9: Qualifications (Certificates (indicate level), Diplomas, Degree obtained)
Qualification(s)
Example: Certificate II in Racing – Stablehand
Please provide a copy of any Racing qualifications
you have already completed.
Rider Development Screening Day EOI 2015
Year Obtained
Currently Studying
2011
n/a
Attached
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Section 10: Work History
Current Employment Status
Of the categories listed, which BEST
describes your current employment
status? (tick one box only)
Company / Employer
Full time employee
Part time employee
Self employed – not employing others
Employer
Employed – Unpaid worker in family business
Unemployed – Seeking full time work
Unemployed – seeking part time work
Not employed – not seeking employment
FT , PT, Casual
Start Date
Finish Date
Job Title Held
Section 11: Sports Experience and Achievements
Sport
Example: AFL
Experience
U14 Western Warriors Northern League
Achievements
rd
Finished 3 2010
Section 12: Riding Experience and Achievements
Sport
Example: Pony Club
Experience
Horsham Pony Club member for 5 yrs
Trackrider / Stablehand for local Trainer
Rider Development Screening Day EOI 2015
Achievements
Various placements at events –
results attached
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Section 13: Medical Information
All health information collected by Racing Victoria will be collected and handled in accordance with its
Privacy Policy, as amended from time to time and published on its website http://www.racingvictoria.net.au.
Have you experienced or do you suffer from any of the following conditions below (please tick)?
Ref.
Condition/Injury/Illness
1.
Nervous disorders including, nerves, depression, nervous
breakdown, mental or emotional instability, anxiety or attempted
suicide.
Yes
No
2.
Headaches or Migraines
Yes
No
3.
Fits, Convulsions, turns, blackouts, giddiness or epilepsy
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
4.
5.
6.
7.
8.
9.
10.
11.
Lung or chest infections, pneumonia, bronchitis, asthma or
tuberculosis
Heart disease, high or low blood pressure, rheumatic fever or
angina pectoris
Indigestion, pain after eating, gastric or duodenal ulcers, hiatus
hernia, gall bladder disease, recurrent diarrhoea or appendicitis
Kidney or bladder problems, cystitis (inflammation of the bladder)
or stones
Diabetes, goitre, thyroid disease or any disease of the lymphatic
glands
Anaemia or blood disease
Perforated ear drums, deafness, tinnitus (noises in the ears) ear
discharge or blocked ears
Sinusitis, frequent head colds, blocked nose, hay fever or other
allergies
12.
Back, spine or neck injuries, pain or arthritis
Yes
No
13.
Fractures or dislocations
Yes
No
14.
Head injuries, knocks or falls during sports or other activities, seen
a Doctor or Hospitalised for head injuries, blackouts or loss of
consciousness
Yes
No
15.
Skin disease, eczema or dermatitis
Yes
No
16.
Speech impairments or defect
Yes
No
17.
Surgical procedures or hospital admission
Yes
No
18.
Any other illnesses or injuries not mentioned above
If yes, please provide details below:
Yes
No
19.
Have you ever made a claim for Workers Compensation
Yes
No
20.
Do you consider yourself to have a disability, impairment or long
term condition? (If yes, please specify below).
Yes
No
Rider Development Screening Day EOI 2015
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Hearing/Deaf
Physical
Intellectual
Mental Illness
Acquired Brain Impairment
Vision
Medical Condition
Learning
Other
Unspecified
If you have answered ‘yes’ to any of the medical information questions, please provide further details
below in the “Details of Condition, Injury and/or Illness” and please ensure you provide the correct
reference number if applicable.
Ref Number
Details of Condition, Injury and/or Illness
Date of last Tetanus Injection / Booster:
Do you smoke?
(if yes, please provide the number of cigarettes or other
tobacco products you smoke per day)
No
Yes
No
*
Do you consume alcohol?
(if yes, please provide the number of standard drinks per
day)
Yes
*
Prescriptions
Please provide details of any oral, intravenous or topical medications currently prescribed for you by
a Medical Practitioner or which have been prescribed for you by a Medical Practitioner in the past.
Also, include any of the following items:
 herbal preparations you use or have used whether prescribed or otherwise
 vitamins or supplements you use or have used in the past
Details of Prescribed Medications by a Medical Practitioner
Rider Development Screening Day EOI 2015
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Section 14: Privacy Statement
All personal information collected and retained by Racing Victoria will be treated in accordance with Racing Victoria’s
Privacy Policy.
If you do not wish for marketing and promotional material to be sent to you, please tick this box
If you do not wish for your photograph to be used for media articles, advertising or promotional material, please tick this box
Section 15: Declaration
By signing the Authorisation below, I:
•
acknowledge that horse riding is an inherently dangerous activity. I acknowledge that there are certain risks which l
will be exposed to during the Screening Day and that accidents can happen which may result in injury or death. I
have voluntarily read and understood this warning and accept and assume the inherent risks in participating in the
Screening Day and agree that I will not hold Racing Victoria liable for any injury suffered as a result of attending the
Screening Day;
•
acknowledge that, if selected, I will incur fees to attend the Screening Day;
•
declare that I understand that it is my responsibility to provide all relevant and required documentation;
•
agree and acknowledge that the giving of false or incomplete information may lead to the refusal of my application
or cancellation of my enrolment at the Screening Day;
•
declare that all information that I have provided within this EoI, including Medical Information (Section 13), and any
other attachments are to the best of my knowledge true, correct and complete at the time of my application and that
I have not withheld any information that is relevant to this EoI;
•
declare that if I am diagnosed with any of the conditions listed in Section 13 or the circumstances of any of the
listed conditions I currently have should change, I agree to immediately advise Racing Victoria’s Chief Medical
Officer (CMO);
•
consent to Racing Victoria collecting health information about me for safety purposes and identifying any potential
risks should l be selected to attend the Screening Day;
•
agree to provide all relevant health information regarding my EoI to be offered a place at the Screening Day,
including information from other medical practitioners/specialists and access to all my pathology and radiology
reports (if required);
•
agree that if it is not reasonable and practicable for me to provide my health information, I authorise consent for
Racing Victoria’s CMO to obtain and collect all relevant clinical information regarding my EoI in participating in the
Screening Day. This includes approval to obtain information from other medical practitioners/specialists and
access to all pathology and radiology reports;
•
also provide consent for Racing Victoria’s CMO, at his or her discretion, to discuss the above health information
with nominated representatives of Racing Victoria and external health and allied service providers contracted to
Racing Victoria (if required). I am aware that information will be used for safety purposes;
•
declare that I understand that l am able to gain access to any personal information that is collected by Racing
Victoria;
•
acknowledge that attendance at the Screening Day does not guarantee the attainment of any registration, license
or permit issued by Racing Victoria and further acknowledge that should l make any such application for
registration, a license or permit that it may be subject to additional requirements, such as requirements set out in
the Rules of Racing; and
•
acknowledge that attendance at the Screening Day does not serve as a pre cursor to acceptance into the
Apprentice Jockey Training Program.
Rider Development Screening Day EOI 2015
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Section 17: Authorisation
Applicant Name
Applicant Signature
Date
Please note: if the Applicant is under 18 years of age, his/her legal guardian must complete the
following section.
Parent / Guardian Name
Parent/Guardian Signature
Date
Please attach relevant documentation.
Once this form has been completed, please return it to the address below:
Racing Victoria –Workforce Development
Attention: Melissa Weatherley
400 Epsom Road
Flemington VIC 3031
Racing Victoria Office use only
Date Received:
EoI Lodged:
Logged By:
Information Provided to EoI:
Rider Development Screening Day EOI 2015
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