Young People

Form - Request for Work Placement

Only complete this form if you are unable to find a work placement in your preferred industry area. Click on “YC4me” located at www.youthconnect.com.au or visit www.youthconnect.com.au/4me and search for work placements.

Type of Work Placement:
Name:
Address:
Home phone number:
Mobile phone number:
Best time to contact student:
Age:
Email Address:
School:
Do you have access to public transport?  Yes No
VETiS Certificate Completing (if applicable):
Certificate (if applicable):  VCE VCAL
Year level:

Preferred work placement dates:

  Term 2 Term 3 Term 4

**All dates fall during school holidays

Term 2 Dates
4 July to 8 July 2011
11 July to 15 July 2011

Term 3 Dates
26 September to 30 September 2011
3 October to 7 October 2011

Term 4 Dates
28 November to 2 December 2011
5 December to 9 December 2011

One day per week placement - for VCAL or Practical Placement
We can be flexible to work around you - some placements run throughout the school term one day per week. Applicable to some VET programs. please indicate the preferred day:

Other - please specify the dates:
Do you have a job at the moment?  Yes No
If so, what is it?
Do you have any contacts that you want us to contact on your behalf? (i.e. organisation name, contact person etc)
Have you completed any type of work experience? If so, where & when?
What area(s) of this industry are you interested in?
Comments: