Student Details

  • Student Name

  • Date of Birth

  • Gender

  • Current School Year Level

  • School

  • School

  • Home Address

  • Home Phone

  • Mobile Phone

  • Email Address

  • Drivers Licence

Emergency Contact Details

  • Emergency Contact Name

  • Relationship To You

  • Phone Number

  • Next Of Kin

  • Relationship To You

  • Phone Number

Traineeship Details

  • Traineeship Name

  • RTO Name (if not Barringtons)

  • RTO Address (if not Barringtons)

  • Host Business Name

  • Host Address

  • Supervisors Name

  • Phone Number

  • Email Address

Bank/Tax/Superannuation Details

  • Name of Bank

  • Account Name

  • BSB/Account Number

  • Superannuation Details (Company/Membership Number)

Privacy Agreement

  • Privacy Agreement Barrington Group Australia Pty Ltd is required to give you information to third parties such as prospective host employers and government departments in order for us to get you employed as an apprentice or trainee. Under the privacy act (revised 2001) we require your permission for your details to be given to those people. We also require your permission to conduct reference checks.

  • Signature

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