Work Experience Placements For School Students
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1
2Work experience placements
for school students
Agreement
Privacy Statement
The Department of Education and Training (’the Department’) is collecting personal information on this form in order to make a work experience
arrangement for a student under the Education (Work Experience) Act 1996. The personal information will only be used by authorised
employees within the student’s school, the Department, and the nominated work experience provider for the purpose of organising and
implementing the arrangement. The information may also be given to the Queensland Government Insurance Fund and WorkCover Queensland
for the purpose of managing insurance coverage as required by the Education (Work Experience) Act 1996 (Qld). Your information will not be
given to any other person or agency unless you have given us permission or we are required by law to do so.
This agreement establishes a work experience arrangement under the Education (Work Experience) Act 1996, and should be completed and
signed, where indicated by the student, their parent, the work experience provider and Principal of the student’s school.
Provider’s
School name:
name:
Provider’s
School address:
A
address:
N
Work Experience
Nominated
D
Coordinator:
Supervisor:
Phone:
Phone:
Email:
Email:
PLACEMENT DETAILS
Industry/
Model of work experience:
Work sampling
Occupation:
Structured work placement
(Select one)
Dates of
Number of
Hours of
placement:
days:
work:
Summary of proposed student workplace activities (list main activities):
Special requirements for placement (e.g. uniform, personal protective clothing/equipment):
STUDENT DETAILS
Male
Student name:
Date of birth:
Gender:
/
/
Female
Phone:
Email:
Emergency
Out of school hours
contact:
emergency phone:
Uncontrolled copy. Refer to the Department of Education and Training Policy and Procedure Register at
to ensure you have the most current version of this document.
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