Student Own Work Placement
Request Form
Students are able to choose their own Work Placement, (IE: one offered by a
family member, friend or another contact). It is ESSENTIAL that the following checklist is completed by
the student and signed off by a parent/guardian and the school. Placements will NOT be approved
without all required signatures. **The teacher and school Principal carry the overall responsibility
regarding the approval of the prospective placement**
Based on the information provided, checks will be made by the corresponding teacher and Business
Education Network and the placement will either be approved or denied. If the request is denied, you
will be offered a placement by Business Education Network, subject to availability.
PLEASE NOTE: REQUESTS NEED TO BE RECEVIED AT LEAST 6 WEEKS PRIOR TO THE
REQUESTED PLACEMENT DATE
STUDENTS: Please answer ALL questions by circling either ‘YES’ or ‘NO’. These questions will need to be
asked to your prospective employer in order to ensure information is accurate. Please also include
details regarding you and the prospective employer on the following page.
1.
YES / NO: During my placement, I will not be involved in hazardous activities or be in an
environment that exposes me to physical or moral danger.
2.
YES / NO: My prospective employer can offer me the minimum 35 hours of Work Placement as
mandated by the Board of Studies.
3.
YES / NO: My prospective employer operates from a business premises & will be able to provide
appropriate on-going support.
4.
YES / NO: My prospective employer has discussed the kind of activities and tasks I will be
undertaking. These are appropriate to course competencies.
5.
YES / NO: My prospective employer has suitable occupational health & safely, anti-discrimination
and equal opportunity practises/guidelines in operation.
6.
YES / NO: The tasks I will be performing are in accordance with the Departments of Education &
Communities/Other providers policy guidelines RE: acceptability to ‘community standards’.
Teachers can provide documentation upon request.
7.
YES / NO: The prospective employer does not have any ADULT/X-RATED content eg: Electronic
media, publication or illustrations.
My contact with the prospective employer was through (please tick):
RELATIVE ⃝
FRIEND ⃝
CURRENT JOB ⃝
OTHER: ______________________________________________________
STUDENT: PLEASE ALSO COMPLETE THE INFORMATION ON THE FOLLOWING
PAGE OF THIS FORM. SIGNATURES ARE REQUIRED.
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Details of Student Own Request
Requested Date for Placement: __________________________________________________________
Student Name: _______________________________________________________________________
Home Ph: ________________________________
Mobile: __________________________________
School: _____________________________________________________________________________
Course: ___________________________________
Year: __________________________________
Teacher: ____________________________________________________________________________
Business Name: ______________________________________________________________________
Contact Person: _______________________________
Position: _____________________________
Address: ____________________________________________________________________________
Phone: _________________________________
Mobile: ___________________________________
Email: ______________________________________________________________________________
Has the Employer been advised of this requested placement?
YES
⃝
NO
⃝
PARENT/GUARDIAN Acknowledgement
I, __________________________________(please print name) being the parent/guardian of the above
named student, hereby give permission for my child to attend the above Work Placement: conditional
upon acceptance of the Work Placement by the class teacher.
Parental/Guardian Signature: ________________________________ Date: ____________________
TEACHER Acknowledgement
I, __________________________________(please print name) being the teacher of the above named
student, hereby give permission for the student to attend the above requested Work Placement. I
understand that I carry the ‘Duty of Care’ as per insurance & protection liability RE: respective educational
systems.
Teacher Signature: ________________________________________ Date: _____________________
TEACHER: Please ensure to complete this 2 page form and either fax or email back to your
corresponding Work Placement Coordinator at:
Fax: 02 9907 1594
Carolina Barajas Email: [email protected]
Kim Walsh Email: [email protected]
**IMPORTANT**
Business Education Network will endeavour to contact the noted employer, explain the purpose of
mandatory Work Placement and obtain the relative confirmation from the employer that they wish to
participate. Business Education Network does not assume responsibility for visiting the employer to
ascertain suitability. Business Education Network will also only pursue the employer for a limited period of
time before the lead will no longer be considered.
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