Registration Form - Work Placement Web by Organise Internet

STUDENT REGISTRATION FORM

STUDENT INFORMATION:

Your name:*


Given name*		Surname*

Home address:*

Suburb:*

Postcode:*

Home phone:*

Student's Mobile:

Email address:

Fax:

Date of birth:*

Gender:*

Male Female

Do you consider yourself to have a disability or impairment:*

Yes No

Please list any allergies, medical conditions, medications you have:

Do you come from a Non English Speaking Background?:*		Yes No	Please specify:*
Are you an Aboriginal or Torres Strait Islander?:*		Yes No

EMERGENCY (GUARDIAN) CONTACT DETAILS:

Name:*


	First Name:*	Surname:*

Contact details:*


	Work/home phone:*		Mobile phone:*

Relationship to student:*

SCHOOL DETAILS:

VET Subjects:
Are you undertaking a subject at TAFE? Select your TAFE campus from the box above and click the circle next to TAFE to the right of your chosen subject.

1:*				School TAFE
2:				School TAFE
3:				School TAFE
4:				School TAFE

School:*

Current Year Level:*

10 11 12

WORK DETAILS:
Are you undertaking a School Based Traineeship? :*					Yes No
Do you have a casual or part time job?:*					Yes No
Details of your employment including name of business, type of work and hours per week*:

STUDENT AUTHORISATION AND AGREEMENT
I agree to the following: I will prepare for workplacement by developing a work ready attitude, neat personal presentation, polite verbal communication skills and complete all required documentation. I will phone and confirm my attendance at workplacement and arrange an interview time if required. I will attend my work site each day for the required hours as indicated on the Student Placement Record. I will contact my workplacement supervisor and school if I will be late or unable to attend workplacement. I will abide by all OH&S policies and practices which my workplacement host has in place. I will not discuss any private information that I am privy to during the course of my workplacement and agree that all such information is confidential. I will write a thank you note to the host employer after completing workplacement.
	I agree to the student authorisation and agreement.*

* Denotes required field.

Privacy Notice: The information provided by you is being obtained for the purpose of work placement for Higher School Certificate. Career Links may use it in organisation of work placement, part time traineeships, post school surveying, media publications and/or promotion. Other people and / or agencies that will be provided with this information are various employers, BVET, DEST and DET. Provision of this information is voluntary. It will only be disclosed for purposes directly related to the purpose for which it is collected. It will be stored securely.