G R A D U AT E D I P L O M A O F L E G A L P R A C T I C E
WORK EXPERIENCE COMPONENT
For Western Australian Students only
A P P L I C AT I O N F O R A P P R O VA L O F P L A C E M E N T
This application form is for prospective and retrospective work experience placements.
Mr
Ms
Mrs
Miss
Dr
College Student ID (if known):
First Name:
Middle Name:
Surname:
Preferred Name (if different):
Date of Birth:
(DD/MM/YYYY)
Gender:
Home Phone:
Mobile:
Work Phone:
Fax:
Male
Female
Email Address:
POSTAL ADDRESS FOR ALL CORRESPONDENCE:
Address:
Suburb/Town:
State:
Postcode:
Country:
PERMANENT HOME ADDRESS (ONLY IF DIFFERENT):
Address:
Suburb/Town:
State:
Postcode:
Country:
C O U R S E E N R O L M E N T D E TA I L S
Have you enrolled or completed the Coursework Component of the PLT Program?
Yes
Course Code
No
If no, in which stream do you intend enrolling?
NSW
QLD
VIC
WA
WO R K P L AC E M E N T D E TA I L S
Organisation/Firm:
Address:
Postcode:
DX:
Telephone:
Fax:
Placement Dates
From:
Number of days in the workplace each week:
(DD/MM/YYYY)
Minimum of two days in any week
To:
(DD/MM/YYYY)
Full-time
Part-time
If undertaking variable days per week or multiple periods of placement, please attach an annexure detailing dates signed by you and your supervisor.
FOR COLLEGE USE ONLY
Approved Date
Student No.
Signature of Applicant
Ensure that you are familiar with the Work Experience Rules, Visit www.collaw.edu.au/downloads Commencement Date
correct as of February 2017
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G R A D U AT E D I P L O M A O F L E G A L P R A C T I C E
WORK EXPERIENCE COMPONENT
For Western Australian Students only
S U P E R V I S O R ’ S U N D E R T A K I N G I N R E L AT I O N T O W O R K E X P E R I E N C E
To be completed by your supervisor or intended supervisor.
Mr
Ms
Mrs
Miss
Middle Name:
Dr
First Name:
Surname:
I am a: (please check the option(s) that apply)
Lawyer who holds a current Australian practising certificate which I have held for at least 2 years;
Judge;
Lawyer who is a member of the State Administrative Tribunal or the Administrative Appeals Tribunal;
Lawyer who has practised for more than two years and is employed by the State or Federal government.
Please state the number of years you have held your practising certificate:
If applicable, please provide details of any restriction or limitation upon your certificate:
My practising certificate was issued in:
(Name of State/Territory/Country)
Current position:
I,
(Supervisor’s full name in capital letters)
undertake to provide/have provided
(Name of Applicant)
with a period of work experience that complies with the Work Experience Rules. I undertake to advise the Work Experience Committee if I become
unable to comply with this undertaking. (delete if retrospective)
I certify that I have not been the subject of an adverse finding by any relevant court, licensing authority or disciplinary body under the law governing
the legal profession in any relevant jurisdiction; or if having been the subject of an adverse finding, I have made full disclosure to the Work
Experience Committee (if applicable, please attach details).
I advise the Work Experience Committee that I will not be supervising more than three other graduates-at-law in work experience placements
concurrently or that I have sought approval to supervise more than three (if applicable, please attach details).
Signature of Supervisor:
Date:
Please fill out this form and email back to: [email protected]
Or mail to: Student Services, The College of Law, PO Box 2, St Leonards NSW 1590, DX 3316 St Leonards
PRINT THIS FORM
Ensure that you are familiar with the Work Experience Rules, Visit www.collaw.edu.au/downloads correct as of February 2017
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