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Student’s & Work Placement

Please complete and submit the form below if you are interested in work experience.

Title:  
Mr Mrs Ms Dr  
First Name/s: Family Name:
Tertiary Institution: Department:
Program / Discipline: Current year of training (1st, 2nd 3rd, 4th):
Institute:  
 
Country of Birth: D.O.B:
Address: Postcode:
Phone: Mobile:
Email: Fax:
   
Do you speak another language?:
Yes   No  
   
Date Requested - FROM: Date Requested - TO:
Select Date Select Date

Availability To Work
Monday:
From Time / am: To Time / pm:
Tuesday:  
From Time / am: To Time / pm:
Wednesday:  
From Time / am: To Time / pm:
Thursday:  
From Time / am: To Time / pm:
Friday:  
From Time / am: To Time / pm:

Preferred work areas for placement:
  1st Choice 2nd Choice 3rd Choice
Reception
Aged Care
Family Work
Youth Work
Playgroup/s
Ethnic Community
(specify from Arabic, Vietnamese, Pacific Islander)
   
Please list all recent qualifications and training apart from your current course of study:
Current drivers license: Drivers Licence No:
Yes   No
   
Access to a comprehensively insurance vehicle: Yes   No
   
Are you willing to work outside of the Campbelltown area? Yes   No
   

Referee – please list at least one referee
Name: Position:
Organisation: Phone:
Name: Position:
Organisation: Phone:
Please list your skills and or work experience including nature of work and dates of employment:
List of hobbies/interests:  

Upon submission of the form, you certify that the information you have provided is true and correct. You understand and agree to the following:

  • MDSI student and work experience placements are voluntary and unpaid.
  • The placement is made for the period requested only, dates may only be extended by mutual agreement between the student and MDSI.
  • While MDSI makes every effort to provide a suitable Student or Work Experience placement for the dates requested, MDSI provides no guarantee that a placement will be made in every case.
  • MDSI reserves the right to refuse Work Experience applications at any time.

Please be aware that upon receipt of your application you may be asked to attend a short interview.
Verification code:  
   
 

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