Student Work Placement (Unpaid)

Bega Valley Shire Council is collecting personal information from you as part of the recruitment and selection process. Bega Valley Shire Council recognises the importance of privacy and is committed to ensuring the privacy of your personal information collected and/or received by us.

1. Yes I agree to the privacy statement*

1. Title* Mr Mrs Ms Miss Dr Other
2. First name*
3. 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. Gender Male Female Non-binary / Non-conforming Prefer not to say

1. LinkedIn URL

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

1. Please outline any restrictions that may impact work placement (if applicable)
2. EDUCATION INSTITUTION DETAILS: Name of Institution*
3. EDUCATION INSTITUTION DETAILS: Institution Address*
4. EDUCATION INSTITUTION DETAILS: Careers Advisor *
5. EDUCATION INSTITUTION DETAILS: Careers Advisor Phone Number*
6. EDUCATION INSTITUTION DETAILS: Careers Advisor Email Address*
7. CERTIFICATE OF CURRENCY DETAILS (INSURANCE): Insurer Name*
8. CERTIFICATE OF CURRENCY DETAILS (INSURANCE): Address*
9. CERTIFICATE OF CURRENCY DETAILS (INSURANCE): Reference *
10. CERTIFICATE OF CURRENCY DETAILS (INSURANCE): Copy of Certificate attached? *

    1. Yes
11. EMERGENCY CONTACT DETAILS: Full Name*
12. EMERGENCY CONTACT DETAILS: Relationship*
13. EMERGENCY CONTACT DETAILS: Address*
14. EMERGENCY CONTACT DETAILS: Phone Number*
15. RELEVANT QUALIFICATIONS ATTACHED: Working with Children Check
    This is mandatory if you are aged over 18 years and seeking work placement in the following sections:
    1. Children's Services
    2. Families, Ageing and Disability
    3. Library Services *

    1. Yes
    2. No
    3. Not applicable
16. RELEVANT QUALIFICATIONS ATTACHED: Police Check
    This is mandatory if you are aged over 18 years and seeking work placement in the following sections:
    1. Children's Services
    2. Families, Ageing and Disability
    3. Library Services
    4. Revenue
    5. Human Resources*

    1. Yes
    2. No
    3. Not applicable
17. RELEVANT QUALIFICATIONS ATTACHED: White Card
    This is mandatory if you are seeking work placement in the following sections:
    1. Water and Sewerage Services
    2. Workshop and Fabrication *

    1. Yes
    2. No
    3. Not applicable
18. PLACEMENT DETAILS (OPTION 1 ): Occupation* Administration Customer Service and Revenue Children's Services Communication and Events Engineering Families, Ageing and Disability Human Resources Information Technology Library Services Town Planning Waste Facilities Water and Sewerage Services Work, Health and Safety Works - Town Teams Workshop and Fabrication Other
19. PLACEMENT DETAILS (OPTION 1): If other, please advise what area you are interested in?
20. PLACEMENT DETAILS (OPTION 1): Start date*
21. PLACEMENT DETAILS (OPTION 1): End Date*
22. PLACEMENT DETAILS (OPTION 1): Days*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
23. PLACEMENT DETAILS (OPTION 1): Why do you want to gain experience in this area? *
24. PLACEMENT DETAILS (OPTION 1): What are you hoping to learn through your work experience?*
25. PLACEMENT DETAILS (OPTION 2): Occupation* Administration Customer Service Children's Services Communications and Events Engineering Families, Ageing and Disability Human Resources Information Technology Library Services Town Planning Waste Facilities Water and Sewerage Services Work, Health and Safety Works - Town Team Workshop and Fabrication Other
26. PLACEMENT DETAILS (OPTION 2): If other, please advise what area you are interested in?
27. PLACEMENT DETAILS (OPTION 2): Days*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
28. PLACEMENT DETAILS (OPTION 2): Start Date*
29. PLACEMENT DETAILS (OPTION 2): End Date*
30. PLACEMENT DETAILS (OPTION 2): Why do you want to gain experience in this area?*
31. PLACEMENT DETAILS (OPTION 2): What are you hoping to learn through your work experience?*