Vocational Placement Request Step 3 of 3
   
Welcome to the vocational placement request form. Please complete the following form for submission to  Sutherland Business Education Network
1. Student Details
School Name: Aquinas College
First Name: A value is required.Exceeded maximum number of characters.Minimum number of characters not met.
Last Name: A value is required.Minimum number of characters not met.Exceeded maximum number of characters.
Home Address: A value is required.
Suburb or Town: A value is required.
State: Please select an item.
Post Code: A value is required.Invalid format.Minimum number of characters not met.Exceeded maximum number of characters.
Home Phone: A value is required.A value is required.Invalid format.
Mobile: Invalid format. (eg 0400 000 000)
Email Address: A value is required.Invalid format.
Date of Birth: A value is required.Invalid format.(format dd/mm/yyyy)
Medicare Number:
Gender:
Year Level:
Are you from a Non-English
Speaking Background?


Are you an Aboriginal or
Torres Strait Islander?

Please select an item.
Do you have a medical condition
or disability that may affect your vocational placement?

Please select an item.
If so please outline the condition or disability here.
   
2. Emergency Contact Information - Parent/Guardian
Guardian First Name: A value is required.
Guardian Last Name: A value is required.
Guardian Phone: A value is required.
Description of Guardian Phone: Please select an item.
Relationship to Student: Please select an item.
Emergency Name & Phone: A value is required. (eg. Joh Bloggs - 02 0000 0000)
 
3. Student Declaration
1. I request that Sutherland BEN obtain a work placement for me using the above information.  
 
2. I understand that the work placement is a mandatory component of the course and agree to follow all requirements outlined in “A Student’s Guide to Workplace Learning”.  
 
3. I understand that my work placement may be cancelled due to unacceptable behavior and in this event I will not be offered another work placement by Sutherland BEN. Unacceptable behavior includes but is not limited to any behavior which is inappropriate, malicious, offensive, illegal or dangerous.  
 
4. I understand that if I cancel my work placement without a valid reason, Sutherland BEN will not rebook a replacement venue for me  
 
5. I agree to phone my host employer 1 week before my work placement to confirm all details.  
 
6. I will obtain all signatures required on the Student Placement Record and return to my teacher. I understand my placement may be cancelled if I fail to return the signed forms.  
 
7. Construction students are advised that they will require White Card Training (NSW) or appropriate OH&S induction before entering workplaces.  

Click the button below to indicate you agree with this declaration and to submit your registration form.
 

 

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