Mackay Regional Council - 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.

Learning institution	University Registered training organisation School
Name of learning institution
Contact person
Contact number
Application completed by:	Student Other (Please leave details below)
Name
Affiliation with student
Contact number
Email address

Title (Mr/Mrs/Miss etc.)
Surname
Given names
Preferred name
Street address
Suburb
State
Postcode
Email address
Daytime contact number
Mobile number
Date of birth

Start date for placement - Option 1
End date for placement - Option 1
Start date for placement - Option 2
End date for placement - Option 2
Summer Placement (Applicable for university students)
What work experience areas are you looking for?
Is this work experience a component of a VET course or University qualification?	Yes, please indicate qualification below No
Name of qualification you are studying
Year (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.	Mackay Sarina Mirani Marian

Work experience application form

Institution details

Applicant details

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.

Declaration of applicant