Youth Employment Pathways ProgramEnrolment form

Your details

First Name

Last Name

Phone Number

Email Address

Age

Preferred mode of contact

Phone callText messageEmail

Suburb:

Referrer contact details
If you have been referred to this program by someone (support worker, employment coach, parent/guardian, etc.), please fill out this section.

Referrer full name

Email Address

Phone Number

Organisation/employer (if relevant)

Young person - further information

Do you identify as any of the following? (If known)

Gender:

Preferred pronouns:

Do you speak any languages other than English?

YesNo

If yes, what languages?

Do you identify as having a disability?

YesNo

If yes, feel free to share more information about your disability and how best we can support you.

Capacity to travel

Do you have a drivers license and access to a vehicle?

Are you able to travel independently (by car, public transport or other means)?

YesNo

Education and employment experience

Are you currently attending school?

Do you have any previous employment or volunteering experience?

YesNo

If yes, please tell us about this experience (organisation, year, role).

Barriers and challenges

What do you think are some of the barriers or challenges you have faced in gaining employment or undertaking further studies?

Are there any further barriers or challenges you want to share with us, that might help us support you?

What do you think are your greatest strengths?

Motivation for joining the program

Do you know what kind of work you are interested in?
(It might be a particular job you are interested in, or an industry/area of work.)

Are you interested in starting an apprenticeship or traineeship?

YesNo

What are your hobbies/interests?

Emergency contact details

Emergency contact name

Relationship

Emergency contact phone Number

Emergency contact email address

Parent/guardian/carer contact details - If under 18 years
Only fill this section out if you are under 18 years old.

Parent/Guardian contact name

Relationship

Parent/guardian contact phone Number

Parent/guardian contact email address

Photo permission

Do you consent to mmvllen taking photographs and video of you throughout the program? We use these images in social media, on our website and in program flyers.

YesNoUnsure