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Student to complete Given names Surname/family names Postal address Postcode Daytime phone number Email address Date of birth Do you identify yourself with any of the following Aboriginal or Torres Strait Islander Yes No Person with a disability or impairment If yes please state special requirements for the work area School name School address Co-ordinators telephone number From to Preferred no. Of hrs/days per week What type of work experience are you interested in in order of preference...
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