Work Placement / Internship Request Form

Your Personal Information

Student Name(Required)

First Last

Contact Number(Required)

Your Email Address(Required)

Enter Email Confirm Email

Qualification currently studying(Required)

Name of the tertiary institution where studying (School, TAFE, University or RTO)(Required)

Tertiary Institution Contact

Name(Required)

Email(Required)

Phone(Required)

Work Placement Support Documents(Required)

Please upload the letter from your tertiary institution that supports work placement AND a copy of insurance document.

Drop files here or

Accepted file types: pdf, docx, doc, Max. file size: 50 MB.

How many hours are required to be completed for the work placement(Required)

Proposed commencement date(Required)

Must complete by date(Required)

Tasks required to complete as part of work placement(Required)

Own transport(Required)

Yes

No

Competency Card(Required)

Please upload a copy of valid competency card

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Availability(Required)

Please indicate days and times available. [start time-finish time]

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Medical Condition(s)(Required)

Do you have a medical condition that we need to be made aware of?

Are you currently looking for employment?(Required)

Yes

No

If Year 10, 11 or 12 School Student

School Placement Record form must be provided with this form.

Accepted file types: doc, docx, pdf, Max. file size: 50 MB.

Is there any other information you would like to tell us?

Work Placement / Internship request

Your Personal Information

Tertiary Institution Contact

Position You're Applying For