Work Experience, Work Placement and Internship Program Application

Program Type

Please select the program type you are interested in*

Work Experience - An introduction to the 'world of work' where unpaid participation is usually through a public high school, private high school or tertiary institution.

Work Placement- A mandatory requirement to complete tertiary coursework.

Internship (unpaid)- A tertiary or post-graduate position which is longer and more in-depth than Work Placement. Requires a fixed-term contract.

Contact Details

Given name*

Valid given name is required.

Family name*

Valid family name is required.

Preferred phone*

Valid phone number is required.

Alternative phone

Email*

Valid email address is required4

Address*

Valid address is required.

Are you over the age of 15?*

Yes

Are you over the age of 18?*

Yes

School/Educational Institution Details

School/educational institution - Name

School/educational institution - Address

Valid address is required.

Year Level

Year 10

Year 11

Year 12

TAFE

University

Other

Course of study

School/educational institution - Contact person

School/educational institution - Contact phone

School/educational institution contact - email

Placement Details

Please list 3 areas of interest# or tell us what experience you hope to gain and let us match you with an area*

#(view a list of our team areas)
AlburyCity teams

Please Note: High risk areas require further AlburyCity approvals.

If you have been in contact with an AlburyCity team about this work experience, please advise of the name of the leader you have spoken with:

Why do you want to complete work experience within the area indicated above? (i.e what are you hoping to achieve as part of the placement?)

What are your preferred placement dates?

Please note: there is a minimum 4 weeks notice period on applications to allow for approvals and processing.

Proposed start date*

Proposed end date*

Preferred placement days and times

Monday

start time

end time

Tuesday

start time

end time

Wednesday

start time

end time

Thursday

start time

end time

Friday

start time

end time

Saturday

start time

end time

Sunday

start time

end time

Do you have a whitecard or are you willing to attain privately if required?

Yes

Is there any further information you wish to include to support your request?

Emergency Contacts

Emergency contact 1

Contact name*

Contact phone*

Valid phone number is required.

Relationship to applicant

Emergency contact 2

Contact name*

Contact phone*

Valid phone number is required.

Relationship to applicant

Liability Insurance

Please attach documentation of liability insurance that provides cover for you*

Choose file

Maximum File Upload 2MB. The documentation of liability insurance can usually be obtained from your Student Guild or Student Union of your educational institution.

Student Agreement Form

Please attach your Student Agreement Form*

Choose file

Maximum File Upload 2MB. The Student Agreement Form can usually be obtained from your school.

Identification

Please attach your Identification document*

Choose file

Maximum File Upload 2MB.

Terms and Conditions

I agree to abide by AlburyCity's policies, procedures and code of conduct.*.

I acknowledge that submission of this application does not guarantee a work experience placement.*

I acknowledge that I may need to apply for a NSW Working with Children Check depending on my placement.*

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We are committed to protecting your privacy. We will only use the information that we collect about you lawfully (in accordance with the Privacy and Personal Information Protection Act 1998 and the Health Records and Information Privacy Act 2002).

We may collect information about you for 2 reasons: firstly, to process your request and second, to respond to any queries which you may have. We will not email you in the future unless you have given us your consent.

For more information about what data we collect, why we collect it, and what we do with it refer to our privacy policy or contact us.