Work Experience Application

PRIVACY & PERSONAL INFORMATION PROTECTION NOTICE
Purpose of collection: Administering the recruitment process
Intended recipients: The intended recipient of the information is Kiama Municipal Council.
Access/Correction: You can access your personal information and it may be available to third parties in accordance with the Government Information (Public) Access Act and Council’s Privacy Management Plan.

You may make an application for access or amendment to personal information held by Council. We will consider any such application in accordance with the Privacy and Personal Information Protection Act 1998.

Storage: Kiama Council is the agency that holds the personal information. Council may be contacted on (02) 4232 0444, or by email to council@kiama.nsw.gov.au or at 11 Manning Street, Kiama NSW 2533. Kiama Council’s Privacy Policy can be viewed at www.kiama.nsw.gov.au/your-council//policies.

1. Yes I agree to the privacy statement*

1. First name*
2. Last name*

1. E-mail*
2. Phone*

   Digits only or add + for international numbers

1. Street*
2. Street Cont.
3. City, Town or Suburb*
4. Postcode or Zipcode*
5. Country*Please choose... AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE INTERNATIONAL OTHER Unknown
6. State, Region or Province*Please choose...

1. LinkedIn URL

   (Please click on your profile and copy the URL from your profile page.)

1. Are you eligible to work in Australia?

   1. Yes - (includes permanent resident or citizen of New Zealand or I have a visa which permits me to work in Australia)
   2. No
2. If you selected 'Yes - I have a visa which permits me to work in Australia' - please specify what type of visa.
3. Please tick the following which apply to you:*

   1. I am a resident of the Kiama Local Government area
   2. I attend an educational institution in the Kiama Local Government area
   3. I am studying a specialised subject with the University of Wollongong/other University/TAFE, which relate to a career with Council
   4. Other program (eg. special employment program)
4. If you ticked 'Other program' provide details of the program.
5. What type of work experience/placement are you looking for?*

   1. High School general work experience
   2. High School work placement (VET course eg Hospitality, Business)
   3. General work experience
   4. TAFE work placement (as part of course requirements)
   5. University work placement (as part of course requirements)
   6. Other work placement (as part of course requirements)
6. If you are a high school student, what year are you in?
7. If you are completing a qualification, what is the name of the qualification?
8. If completing a qualification, is the work experience/placement compulsory as part of your studies?

   1. Yes
   2. No
9. What is the duration of your work experience/placement (number of days or hours)?*
10. Is this a block placement or part time placement?*

    1. Block placement
    2. Part time placement
11. The preferred commencement date is:*
12. Date to be completed by:*
13. Days available.*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
14. What is your area of interest / which area of Council are you seeking a work placement?
15. Do you have any special requirements that may impact your ability to perform work experience tasks?*

    1. Yes
    2. No
16. If, yes please provide details
17. Name of school, TAFE, University, training organisation, placement organisation*
18. Name of teacher / placement coordinator*
19. Contact number for teacher / placement coordinator*
20. Email address of teacher / placement coordinator*
21. Do you have any further details that would assist Council in reviewing your request?
22. Declaration
    To be considered for a work experience placement you must acknowledge that you understand and agree to the following conditions (tick each box ):

    1. I will perform my duties during the placement to the best of my ability and will comply with all reasonable directions of Council and employees.
    2. During my placement I will have access to information which is confidential. I will not convey to any person outside Council's workforce any knowledge or information which is gained in the course of the placement.
    3. I agree to conduct myself under the guidance and supervision of the Council employee responsible for the area of work for which I have applied.
    4. I agree to contact Human Resources if I intend to vary the nature of work specified in this application or if I experience any problems with the work I am undertaking.
    5. I understand that Council may terminate my work experience placement if I do not comply with any aspect of this agreement.
    6. I agree to inform Council of any injuries sustained whilst undertaking work experience activities.
    7. I understand I am expected to maintain the same standards of confidentiality, courtesy and organisational discipline as Council's paid employees.
    8. I agree to conduct myself in a cooperative way and comply with any safety procedures.
    9. I understand that as a work experience placement I will not be receiving any remuneration for my services.