Killara Foundation Training and Employment Intake EOI

Program Expression of Interest
Personal Details
Name

Given NameSurname
Date of Birth

MonthDayYear
Date
Address
Suburb
Post Code
Home Phone
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact Details
Secondary Contact Name
Relationship to you
Address
Suburb
Post Code
Home Phone
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Email Address
example@example.com
Additional Information
Current Status: are you Studying, Employed or Unemployed?
Give details
Have you previously completed any qualifications? (Incl. Certificate I,II,III; VCAL; VCE)
Give details
Are you of Aboriginal and/or Torres Strait Islander descent?
Who is your Mob?
Do you speak any other languages? Yes (give details) or No
Give details
Do you have any other work experience?
Give details
Are you currently connected to any other supports?
Give details: Name, Organisation, Position, Contact Details incl. phone & email)
(This form is used to secure consent for Killara Foundation to release information to third parties to assist in the management of a candidates participation in our Programs. Third Parties include but are not limited to; Support Persons, Specialist Services, Treating Doctors, Psychologists, Rehabilitation Providers, Family, Employers & Educational Institutions).
Signature
Date

MonthDayYear
Date
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Program Expression of Interest