Work Experience Request Form

To be completed by student

Please note: Applications for the Glenfield Road Animal Shelter (GRAS) and Botanic Gardens Zoo and Aviary will require proof of immunisation for Q Fever. Applications for Parks and Gardens will require proof of immunisation for Hepatitis B. This will be required to be emailed to prior to commencement of work experience or volunteer placement.

Preferred Dates

(Disability includes physical, neurological conditions (such as Asperger’s), speech, learning difficulties (such as dyslexia), mental health (such as anxiety, depression) hearing loss and vision impairment.)

Privacy and Personal Information Protection Act 1998

The personal information provided in this document is protected under the Privacy and Personal Information Protection Act (PPIPA) 1998. Wagga Wagga City Council must not disclose your personal information to any person or body if it is not directly related to the purpose for which the information was collected.

The following section MUST be completed for your request to be considered.

To be completed by your Learning Institution

(If your address can't automatically be found, you can still enter it manually)

A copy of your certificate of currency of public liability insurance MUST be attached (current copy).

Please note: maximum file size is 10MB

I certify the above student is covered for the duration of their work experience placement with Wagga Wagga City Council under the learning institution’s relevant liability insurance.

If you are a student at a NSW Public School or External VET (EVET) provider it is a requirement of the NSW Department of Education that a Student Placement Record (SPR) is completed.

It is the responsibility of the learning institute and/or applicant to ensure that this is completed prior to attending a work experience placement.