Work Experience - Expression of Interest

Full Name *

Address *

Street address *

City *

State *

Postcode *

Phone number *

Email address *

Current level/course of study *Other examples - High school (please include any relevant subjects or interests) \ Diploma of Early Childhood Education and Care

TAFE, School or University details

Name of institution *

Institution address *

Street address *

City *

State *

Postcode *

Institution contact - name *Careers advisor, Subject lecturer etc.

Contact's phone number *

Contact's email address *

Emergency contact details

Emergency contact - name *

Relationship with you *Mum, friend, housemate etc.

Emergency contact phone number *

Emergency contact email address *

Placement Details

Placement type *

High school work experienceTAFE or Vocational Education and Training Institute work experience School for people with disabilities work experienceUniversity work placementOther

If other please specify

Is this placement a course requirement? *

YesNo

If you are applying as a high school student you will be required to submit a copy of your Work Experience Agreement Form.

Placement preferences

What area of Council would you like to be placed in? *Make sure this is relevant to your current studies.

What dates would you like to complete a placement? (You must apply at least 4 weeks before the proposed start date) *

How many hours do you need to complete? *

What do you hope to achieve during this placement?

What can you offer QPRC or what sets you apart from others seeking work experience? *

Do you have a current NSW Working with Children Check? *

YesNo

Do you have a current White Card? *

YesNo

Have you previously been in contact about work experience?

YesNo

If yes, who were you in contact with?

Do you have any questions for us?

Do you have any medical requirements for your placement? *Please include medical, physical or mental conditions, including special needs that may need to be considered.