Work Placement Web
STUDENT REGISTRATION FORM
STUDENT INFORMATION:
Your full name:*
Given name* Surname*
Your Board of Studies number:
Home address:*
Suburb:* Postcode:*
Home phone:* Student's Mobile:
Email address: Fax:
Date of birth:*
Gender:*
Do you consider yourself to have a disability or impairment:*
Please list any allergies, medical conditions, medications you have:
Do you come from a Non English Speaking Background?:*
Are you an Aboriginal or Torres Strait Islander?:*
 
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:*
2:
3:
4:

School

Select:
Teacher Name:*
Contact Number:*
Teacher Mobile:
Teacher's personal school e-mail address:*
Current Year Level:* 10
WORK DETAILS:
Are you undertaking a School Based Traineeship? :*
Do you have a casual or part time job?:*
Details of your employment including name of business, type of work and hours per week*:
 
COMMENTS:
Your comments:
STUDENT AUTHORISATION AND AGREEMENT
I agree to the following:
  • I will prepare for work placement by developing a work ready attitude, having a neat personal presentation, using polite verbal communication and completing 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 Workplacement Contract.
  • 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.

ALL STUDENTS MUST COLLECT THEIR AUTHORITY TO PUBLISH FORMS AND GET IT SIGNED BY THE PARENTS. STUDENT WILL NEED TO SUBMIT THE SAME TO THE TEACHERS FOR THE REGISTRATION PROCESS TO BE COMPLETED.

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. North West Business Education Network 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.