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Contact
Workplace Learning- Placement Preference Form
Placement Year
(Required)
Placement Number
(Required)
Placement 1
Placement 2
Applicant Information
Name
(Required)
First
Last
Student Year Level
(Required)
Mobile Number of Student
(Required)
Placement Day
(Required)
Suburb of Placement
(Required)
Mode of Transport to Placement
(Required)
Placement
Have you confirmed your work placement?
(Required)
Tick YES if you have pre-arranged a work placement with a host employer. If you need our Workplace Learning Coordinator to source a host employer for you, tick NO.
Yes
No
Company
(Required)
Contact Person Name
(Required)
First
Last
What job will you be doing?
(Required)
Address
(Required)
Street Address
Suburb
Post Code
Phone
(Required)
Email
(Required)
Preference 1
(Required)
Please list the top preference company and job you where you would like to complete workplace Learning. Note, you do not have to contact the employer, but do need to look up and record their contact details. If you don’t have the contact name, just indicate that in the box.
Company
Job you'd like to do
Address
Contact Name
Contact Number
How did you get this contact? (Own contact, provided by the school or other)
Preference 2
(Required)
Please list the second preference company and job you would like to do.
Company
Job you'd like to do
Address
Contact Name
Contact Number
How did you get this contact? (Own contact, provided by the school or other)
Preference 3
(Required)
Please list the third preference company and job you would like to do.
Company
Job you'd like to do
Address
Contact Name
Contact Number
How did you get this contact? (Own contact, provided by the school or other)
Preference 4
(Required)
Please list the fourth preference company and job you would like to do.
Company
Job you'd like to do
Address
Contact Name
Contact Number
How did you get this contact? (Own contact, provided by the school or other)
Preference 5 (optional)
Please list the company and job you would like to do.
Company
Job you'd like to do
Address
Contact Name
Contact Number
How did you get this contact? (Own contact, provided by the school or other)
Preference 6 (optional)
Please list the company and job you would like to do.
Company
Job you'd like to do
Address
Contact Name
Contact Number
How did you get this contact? (Own contact, provided by the school or other)
Declaration
I UNDERSTAND:
1. All sections on the form must be completed in full.
2. Preferences must be realistic. I should have an idea of the job role and the tasks I am likely to be undertaking.
3. Once a placement is organised there should be no changes and I am committed to finish the placement dates.
4. If I lose my placement as a result of poor attendance, lack of interest/enthusiasm, bad attitude, poor performance etc. I may be required to find my own alternative placement.
5. I must act in an exemplary manner at all times in the workplace and can be withdrawn for misconduct. I represent Workplace Learning, my school and myself.
6. I must inform the HOST EMPLOYER, WORKPLACE LEARNING COORDINATOR and MRS BYRNES if I am going to be absent from the workplace, giving as much notice as possible.
7. I must advise the Workplace Learning Coordinator Sandra Rosandich and Mrs Byrnes of any issues associated with the workplace.
8. Workplacement commitments receive priority over all after-school activities.
9. I may need to travel a distance to my work placement which may include using public transport.
10. I may make up absent/extra days by negotiating with the workplace supervisor and need to communicate these with the Workplace Learning Coordinator and Mrs Byrnes.
11. I am responsible for bringing my logbook to the workplace each day and for completing all tasks to meet ADWPL requirements including showing your logbook to Mrs Byrnes each week (unless you are doing a block placement which will require you to show your book to Mrs Byrnes when you return to school).
Student Signature
(Required)
Date
(Required)
DD dash MM dash YYYY
Parent/Guardian Signature
(Required)
Date
(Required)
DD slash MM slash YYYY
Parent/Guardian Name
(Required)
First
Last