work placement application form. - Parks Victoria

APPLICATION FOR WORK EXPERIENCEDANDENONG RANGES GARDENSApplicant details:Name:Address:Date of Birth: …./…./19….Male ❏ Female ❏Country;e-mailAddress:Please attach arecentphotographhereThe work experience program;! Please note that the work experience undertaken with Parks Victoria is on avoluntary basis and no payment shall be made to the student.! Students will be provided with fully furnished accommodation! Students must pay for their airfare, steel capped work boots, food and personalneeds including entertainment and weekend travel during their staySome information about your school;Name of the course/ program:Major Subject? (Eg. Horticulture)Name of School:Address:Country:Telephone:Facsimile:Contact person:Position or title:e-mail Address:What dates do you propose to undertake work experience? Start; …./…./ 20….Finish; …./…./ 20….Do you require airport pickup?If you don’t know your flightdetails they can be forwarded ata later date.No ❏Yes ❏date arriving …./…./20….Airline; ……………………Flight Number …………arrival time:……………am/pm Australian time1 of 3

Some information about yourself;Who could we contact at home in case of emergency?Name:Address:Country:Telephone: Daytime: Evening:e-mail Address:Relationship to you:(eg. Mother)Do you have health insurance? Yes ❏ No ❏Do you hold an International Drivers Licence?Yes ❏ Licence Number;………………………..No❏Which languages do you speak?❏ English❏ French❏ German❏ Japanese❏ Italian❏ Spainish❏ Other,……………………Your work placement:Which skills do you wish to develop?❏ practical horticulture❏ plant identification❏ management of gardens❏ other? Please specify:………………………………………………………………………………………What do you expect to learn during your work experience placement?Please attach a copy of your current resume/curriculum vitae to indicate yourexperience in Horticulture.2 of 3

Please return form to:Annette ZealleyAlfred Nicholas GardensSherbrooke RoadSHERBROOKE VIC 3789AustraliaFax: (03) 61 3 9755 2908Ph: (03) 61 3 9755 2913Or e-mail form to:azealley@parks.vic.gov.auPlease note:In order to facilitate a prompt response to your application please e-mail (or fax as asecond option) this form if you are able to do so. You can later send the applicationwith a photograph attached via the post.3 of 3