Work Placement Web
STUDENT REQUEST FORM
STUDENT DETAILS:
Name:*
Given Name Surname
Home Address:*
Suburb:* Postcode:*
Home Phone:* Student's Mobile:
Email Address:
Do you consider yourself to have a disability?
Describe any illness or medical condition that may cause concern whilst you are in the work place:
 
EMERGENCY (GUARDIAN) CONTACT DETAILS:
Name:*
Given Name:* Surname:*
Contact details:*
Work/home phone:* Mobile phone:*
Relationship to student:*
 
SCHOOL AND SUBJECT DETAILS:
Studying at:*
School:*
TAFE Campus:
Current Year:* 10
Subject:*
Date/Group:*
Teacher:*
Other VET subjects:
Hours required:*
 
DETAILS OF PART TIME WORK:
Do you work part time:*
If yes where do you work?
Approximate hours and days worked
 
If no, have you ever worked part time:*
If yes where did you work?

CAREER INTENTIONS:
After your HSC do you plan to:
Do you want to work in this industry when you leave school?  
If Yes: What would you like to do in this industry area?
If No: What Job would you like?

COMMENTS:
Comments:
If you have specific employer preferences please list. Also describe any travel requirements
STUDENT AUTHORISATION AND AGREEMENT
  • I will perform my duties during the placement to the best of my ability and will comply with all reasonable directions of the host employer and its employees
  • I have participated in preparation for workplace learning and am aware of my rights and responsibilities.
  • I have access during the placement to information that is private and confidential, I will not convey to any person outside of the host employer's workplace any knowledge or information which is gained in the course of the placement.
  • I have made note of any illness or medical condition that may cause concern whilst I am in the work place.
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.