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)

Has the workplace agreed to take you?

Yes

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 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 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 BEEDIE 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 Beedie 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 Beedie.

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 Beedie each week (unless you are doing a block placement which will require you to show your book to Mrs Beedie when you return to school).

Student Signature(Required)

Date(Required)

Parent/Guardian Signature(Required)

Date(Required)

Parent/Guardian Name(Required)

First Last