Mes’ Boerner (ot cutesy Unrelirecaittitel Ze) fi Education and Training SRDEEERTS Surmame She : Fret Name Young) Bith Date 3.4104 1/ 99P Seto Name and dares —Raluagas High Sch Buchdnaa “Avenue Neil Baba Posicode a)" Telephone OR OR 14 7a j). Work Experience Coordinator Nicnlo Aaqdg:|ou ‘Student Year Level 7 EXGESE OF AN EMERGENCY, THE EMPLOYER SHOULD CONTACT THE STUDENT'S PARENT OR GUARDIAN ANDTHE ‘WORK EXPERIENCE COORDINATOR: Reform Act 2006— Ministerial Ordo 382: Work Experience Arrangements (Schools) Name (ParenGuarcan) ding Wu Adiress 13 Cheadle] Faas? Mab DD - Posisode 27 = Tel. (Home), 2 Oy — Work) OF 32447 (Mobile) 94,3394 £44 _ Emegency conic (Name and Tel)_—Aliag Ags Tay Tan nay na 2 an other purpose, Heat information wil be provided i tho Student has @ mecleal condition arenes seems {that may be relevant to thelr placement. This information must be kept confident TREES i ti Hi PRIVAGY INFORMATION: The Information provided on this form Ts for the administration of Work ‘Experience Arrangements only and * Empoyer (business) rama Tel Su Burnes arose OS Co s q Postcode “Typo otindusty avic Primary actviy a workace ce ‘Shudents werk loalon adress, Z Pstoode ‘Workplace contact person > 2o ger ~ Supervisor. ‘Activ th etudent will undertake (¥ sullen epee, allach sapere sheet), ‘Wk Exports hows ‘an om, = onli on Sienday GW ocsday GWesresday GFThusday Piday {rom (conmencamsnt dale) = Dace Vi Z to (comlation date). 201 Total numb of ays, Fate af payment § Ai ax day (85.00 per day imum) S91 < nN 2 PEOF N CRON SU eS CTSE EY £ [name ot ncvidual, or on tehal ofthe Employer Employers an incorporated body) agree that: + ra aentantcupatonal reall and alt isan and standards tlevnt othe condut of my undetaing and wil comply th tego las and standards with respec tothe Student asf the Studonl wore my employee, Fees ame antazar relevant othe conduct of ny undertaking a wil assosa and contol al related rks. have not conrold all related {sk wlio the echool fis fact rr to the Werk Exparionce Arrangement Sommers, tre al auto te Deparment of Education and Early Chidhood Development Wark Experence Guidelines for Employers wit Erpeionce Arargar rg tin, superision and slo eytams a wrk are proved lr the Student to maintain a safe aed eatty Wek Experionce Arangament at al imes. «deren ead lak nto account the competency, maturiy and physical capabilties ofthe Student in elation to all aces he or she wi undertake. The Student's program of actives willbe planned and earied oul mth these onsen ech F ramarapat# Supers (or Suparzore) othe Sidon wo wl be responce for eosin aly chigaons asthe Saden's Enplayer ae cariod out, © reas ge atone formalin, rai, instucton and suparision othe Student in respct of eecupatlonl heat and sally are wi Pave any equipment andor cothing which is required to comply with my duly af care towed the Stcaery {it ensure that the Work Experience is undertaken ina non-cleoriinatory as evasonent hee os ee ant dann re ea Ste workace and contact wah the Student by te Ptncpal orth Work Esperance Coardnaler at any reasonable tine ‘during the Work Experience Avrangement © conta hatte Work Expefence rangement sna used asa substvie forthe employment of employes ortho engagement of {tractors andthe ayinentofanropat wages or 00 for sores to employees ee Cntectons respecte 18 inane eet the maxéum eumbor of studsnis inthe woriglace does net exceed ane Sturt fr every ree employees rr dens 102 engage mor than the permitednumbor a Work Exprence Studer, conn hal deal supartetorvel be povided fora Students. 72 Fe ronnie as elon’ ny noassary hea llomaton a rela othe Student cmt hat vl atin he confer o mdiet emorgoraia” and only close this intrmaton to anether pati wealment is required fra known medical candioeer there ota ‘medical emergency. 18, {wil nity he Work Experience Coordinator as socr as’ possible i the Studer ‘he Work Experience TE Lit concult wth the Principal 1 consiorH necessary lo terminate th Azrangemont botore the specod tim. 18 Thana eee ngea thenduaty to whlch tis rangement les includes ptenalexpvir of he Steno sched cardhageie Subslances andor other hazardous substances as detinadin the Occupational eait and Salty epulabers ach the Student isa Child (under 15 years of age): 16 fina oe Pungcianed a Chis Employrent Perit and tht ary Supanisr has acrert Assessment Nace and pov cre copies ‘of hese to the Principal, Tr Ne ring tar east ores a lovan! change i ecurstances vith esac to @ Superior as spect im cocton 22 ot sujet Cen Act 2008 (Ve) including, it he Supensr is charged wih consid oo tune gully of sroaret hoes oe Sipeninor ng cblaations an extended supervision ert, supervision order, deitlon ado or arava fining s mace ese Supervisor 18 tne eae neal inmedalely i Supervisor's Issued with an interim negative nals ora negative neice thin he manng of eeton 9 ‘ofthe Werking with Chiron Act 2005. (other ora oe ae fespostliles se out above, Following the Princ review ofthese deals, lundertad that he rsh il determine ‘Whether or not the Student will undertake the Work Experienee Avargorent nonased ere Signature _ 2 Is osent, inured or becomes inthe course of undertaking pee 27 Ly5 ‘agyae fo take pat Fi cary out jonaible and lawful directions of the Employer and perform my work to the best of my abil; comply wth al reasonable workplace rules and roqulroments governing safety and behaviour; atfond at th workplace on each day atthe agreed tne; GD intoem bots the Employer and tha Werk Experlonca Coordnateras soon as possible lam unable to allend work: grampiy itor the Employer ot any accident, injury or incident that may occur; {ress aporopristoly for tho workplace; agree that no payment wl be made te me if he placement ie with a Commonwealth Department or body estabilshed under @ Commonwealth iat ove my consent to conatng back payment whore the placer iwi an cgeiaon engages holy or may nan edicaon) chatter Sruniy were sre tt consu pot ae wrare have Glered at awh my ayant we dort back ro crgeraaton, Students aged 18 year 1 agra to Intorm the Employer of any necessary médical Informatio, including detals of any known medical condition which may affect me and any meeieaton or weatment which may be relevant. GN uncerstand that | am responsible fae my ienspert to an from the workplace, | understand thal he Principal wil determine whether ar not will undertake Wark Experience | acknowledge tha aor to commencing the placement under bis Arrangement Iwill complete tne cacupational health and salety program required by the Department of Education and Early Ente meer Vd, Studonte sgnate nd ov 1 in consent omy chi taking par nthe Work Expeenoe Arangemant ard agree that Ke or she willbe subject to the direction and control of ho Employer and nominated Supervisor(s); Uneostand that al roscanabe cae fr the haath ard salty omy chil lb tan byte Eloer aed nominates Suparie(s pect my chido comy vith al reasonable worglace res and requeent governing sll and bahavur Ueereané hal am respon for my cl vansport oan om the waka; fagfoe tet no payment wt be rad o my chi if th placement i wth « CommonweathDapatmart ora body etblshed under & Commanvoat At {ve my conson omy hil donating back payment whore the placements wth an organisation engaged wooly or many in an edeatina ‘Sharabo or communty walre concent condvtod fo pot nd where my chidhas tern th the whole of i chr pyre wl be yomectenecariatn cncertad hal of be nied a son as posse inthe eet ness of or cd omy ci, but ware iis mace to commune vith me Tauetote pore nchargo at he worpaceo tho ompoyar to conor tomy id recon such meseal ard sre! oun Uelodg ie adrinstston a en ance tay be deus etseery by legal quafed made! pracne, and admit uch trata os adj tobe reaonaty necseay 4 tach datas ry Known mala onion ich may elect my cl, and any medal or teen wich may be rolvan ghe my consent oth rlaze fan neessny heal iefermaton in lation oye by the Pinal the Eyer, or hich the Pinal Bova a andy dose pursuant th Heath Records Ac 2008) Lundrtand thal he ra wl dterine vee ort myc wl retake Work Expornc Senate %< i a eS RTS “Te Students covered for WoukSae Inuranco bythe Doparmon ot Ecueston and Eaty Chidhond Development (Sata of Vitor). The Stunts ered pubic ey nsrane accordance vh Mest Order 32 ~ Work Exprencs rangomont, forthe arengomert taken ot by he forty iad below (nal tof ne appro ot TD Doparent of E6scaton and EatyChidhod Development O Nonoverrmantsciact 2 Enployer. NOTE: PUBLIC LIABILITY INSURANCE Pr abit rerarce eae 10 illon cover pr overt st beheld eke ou, roth Student commencing Wak Expaence under the Arangement 1 inn an Arangomenti etre int by a Pincpal of a Govenman hos! in respect ola Goveinnt Scho student, by the Department of etalon and Cary Cnlhood Davlontent inthe insures bag the Studer ard the Employer i wnonanAangomeriTo ented fe bye Pinal Non Govstnment School n respect tt Nor-Goverment Seal stodent ther 2. phat Seven wate ered being te Schoo andthe Sua 8 Bite Enolyer wih he sured beng he Employer andthe Suter, the Piacoa ef hat Schoo hos add the Employer at hat er) porte te Sdedconmonong wok oxpatince thal he Seal des neha publelalyheuaran Se sett above, PEO NeS \ Principal of Parent or Guardian Date Jt ‘enter into an Arrangement forthe above named Student of tis school to be engaged forthe purpose of Work Experlence by the Employer famed above in accordance withthe proieians of the Education and Training Roform Act 2006 and Mcisteial Order 382 ~ Work Experience Frrangements, and on the basi ofthe information provided above and the employers acknowledgements. | confirm that | have informed the Employer as to unelher this schoo! holds public lebityinsuranco. | wil ensure that the above mentioned student wis complete the required ‘ecuptlonal neath and selely program prot to commencing the placement under this Arrangement Ose 1 Principe signature