Work experience application form

Information for applicants:

• Please complete this form to register you interest in undertaking work experience placement with council.
• Human resources will notify the institution and/or applicant as soon as possible whether or not the placement is able to be made.
• This form will not be accepted by council any later than four (4) weeks prior to placement.

Students must be registered with a recognised school, tertiary institution or referral agency that covers them for personal insurance and public liability.


Institution details

Learning institution
Application completed by:

Applicant details

(Mr/Mrs/Miss etc.)

Placement requirements - Having more than one placement option will allow council flexibility in assessing the application. There is no guarantee that council will be able to accommodate placement options, as placements are subject to the capacity of the business area.

Start date for placement - Option 1
End date for placement - Option 1
Start date for placement - Option 2
End date for placement - Option 2

(Applicable for university students)
Is this work experience a component of a VET course or University qualification?

(For example, first, second)
Please select your preferred location for placement
Please note: Transportation to and from the preferred work location is the responsibility of the work experience applicant.

Declaration of applicant

I, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this application with Mackay Regional Council. Should any of the details given in relation to this application be changed in the future, I shall advise council in writing prior to any such changes being implemented. I am prepared to provide documentary proof of citizenship or legal entitlement to work in Australia, if required. Do you agree?