APPLICATION FORM AND REFERRAL FORM

REFERRAL CONTACT NAME

REFERRAL CONTACT POSITION

REFERRAL CONTACT EMAIL

REFERRAL CONTACT PHONE NUMBER

CANDIDATES NAME

CANDIDATES PREFERRED NAME

AGE

DATE OF BIRTH

CANDIDATE’S ADDRESS

CANDIDATE’S PHONE NUMBER

CANDIDATES EMAIL

PARENT/CARER NAME (IF REQUIRED)

PARENT/CARER CONTACT NO

PARENT / CARER EMAIL

REASON FOR APPLICATION OR REFERRAL

Any other information that may be useful for the team to know (e.g., barriers or issues preventing work or study)

Is the candidate interested in Careers Counselling? Support to identify a suitable role.

Yes No Not Sure

Is the Candidate in agreement with this referral? (If required):

Yes No Not Sure

Does the Candidate have a preferred industry or career path? If so, does she have a role in mind?

Clean Energy Advanced Manufacturing Construction Digital & Technology

Is the parent / carer aware of this referral? (If required):

Yes No Not Sure

Please tick as appropriate:

Young person is a school leaver Young person is in some form of post school education or training Young person is working 8 hours per week or more

Is the Candidate enrolled in school?

Yes No Not Sure

Is the candidate participating in any Commonwealth or State transition program, or registered with a job active provider?

Yes No Not Sure

Does the Candidate have any work experience?

Yes No Not Sure

If yes, please provide summary

Young People, Bright Futures

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