Information
-
Student Name/School/Host Employer
Student Details
-
Student Name
-
Date of Birth
-
Gender
- Male
- Female
-
Current School Year Level
-
School
- AB Paterson
- All Saints
- Aquinas College
- Benowa High
- Coombabah High
- Elanora High
- Emmanuel College
- Hillcrest College
- Keebra Park
- Liverstone College
- Marymount College
- Merrimac High
- Miami High
- Nerang High
- Pacific Pines High
- PBC High
- Robina High
- St Andrews College
- St Hilda's
- St Michaels
- St Stephens College
- Southport High
- Trinity Lutheran
- TSS
- Upper Coomera College
- Varsity College
- Wynnum SHS
- Other
-
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
