Personal Details GenderMaleFemale Next Home Address BackNext Medical Information Does the applicant have a health problem or disability which may affect their training as part of an Internship with a Host Organisation ? Choose HereYesNo Does the applicant have any special requirements or require special equipment to perform their duties as part of an Internship with a Host Organisation ? Choose HereYesNo Does the applicant have a health problem or disability that will require them to take medication during the Internship period ? Choose HereYesNo BackNext Emergency Contact BackNext Passport Details First visit to Australia *YesNo Is the applicant eligible for a Working Holiday Visa 417 or 462 Choose HereYesNo If you are unsure, visit http://www.immi.gov.au/Visas/Pages/417.aspx & http://www.immi.gov.au/Visas/Pages/462.aspx BackNext English Classes (min. 2 weeks with B2 level) Current English Level BeginnerElementaryIntermediateAdvanced Other Languages studied and level of knowledge BackNext Internship Internship fields in order of preference Note – While we will make every effort to arrange an internship in the chosen industry, factors such as education and experience as well as the current industry availability may effect a successful placement. Please indicate if the internship is a requirement of your university studies and state any mandatory guidelines : University contract in English Final Report Supervision by specific Professional Other BackNext Educational History Highschool University Number of Years Apprenticeship BackNext Additional Qualifications Please state any areas of computer knowledge: Word Outlook Power Point Programming Photoshop Accounting Please indicate any key skills obtained from any prior jobs / internships: BackNext Expectations of the internship Please provide brief details of what the applicant wants to achieve from the internship and the skills they wish to gain. This should be addressed more comprehensively in the cover letter. BackNext Additional Services Accommodation assistance required ? Choose HereYesNo If yes please indicate if you smoke are allergic to pets ? Choose HereYesNo Will the applicant require an Airport Transfer on arrival ? Choose HereYesNo Will the applicant require assistance arranging insurance ? Choose HereYesNo BackNext Acknowledgement The information given on this application form is to the best of my knowledge complete and correct and I understand that IPI shall have the right to terminate the Internship Placement at any stage if proven otherwise. Should any changes to these details be made at any time before and during the Internship, I will inform IPI immediately. The applicant understands, acknowledges and agrees to the booking conditions of IPI and will obtain insurance cover for Medical, Accident, Travel and Personal Liability and such copies are forwarded to IPI in English and obtaining the correct visa is the interns responsibility. The applicant understands, acknowledge and agrees that the internship arranged by IPI are not employment, but are a voluntary temporary training experience which does not lead to employment. The applicant is aware that a $500 deposit is due upon application and cancellation fees apply. Signature applicant : Back
