Work Experience and Student Placements Application

 This application must be submitted by no later than 4 weeks prior to the available placement
opportunity you are interested in.
 Complete all questions/sections of this form including the placement opportunity you are
applying for.
 Attach additional documentation as required
o School students – a School Workplace Learning Agreement
o All other students – evidence of insurance coverage by your educational institution
 Applications will not be considered if all required documentation, as stated above, are not
submitted with this application.

Personal Details
First Name:
Surname:
Address:
Postcode:
Contact Phone Number:
Email Address:
Date of Birth:

Do you have any special needs YES  NO 

or requirements?
Please provide details

Where are you studying?

Name of school /college / university:

School year level (if secondary school):
Field of study (if university/college/tafe):
Name of degree studying:
Name of work experience coordinator:
Email address of coordinator:
Phone number of coordinator:
Comments:
Placement Opportunity Details

Please advise which placement opportunity you are applying for (refer to opportunities listed on
the City of Onkaparinga website):

Area of interest:
Preferred Start Date:
Preferred End Date:
Preferred Days:
Preferred Hours:
Other Hours:

Briefly describe what interests you

about this area.

INSURANCE REQUIREMENTS

Students are required to be covered by the following insurances:

 Indemnity/Public Liability
 Personal Accident/Illness

School students – the School Workplace Learning Agreement form supplied to you by your
school provides proof of insurance and must be attached to this application.

TAFE students – the Vocational Placement Agreement form supplied to you by TAFE provides
proof of insurance and must be attached to this application.

Other students – your educational institution needs to provide you with a proof of insurance
document for you to include with this application.

Applications will not be considered if all required documentation, as stated above,

are not submitted with this application.

I certify that the above information is true and accurate and I have attached all required
documentation.

Student’s Signature: ________________________ Date: ___________________