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Our Services
All Services
Supported Independent Living (SIL)
Short Term Respite (STR)
Individual Support
Group Support
High Intensity Support
Our Locations
Adelaide Hills & Strathalbyn
Fleurieu & Kangaroo Island
Limestone Coast
Murraylands
Riverland
Southern Adelaide
What’s on
All Events
All Abilities Festival
CommuniTea
Myriad
Rock the Fleurieu
Support Us
Ways to Support Us
Donate
Corporate Partnerships
Volunteer
Bequests
Shop
About Us
Our New Brand
Work with Us
Latest News
Our People
Our Stories
Our History
Resources
Get in Touch
Feedback & Complaints
Privacy statement
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Work Placement Application Form
Name
(Required)
First name
Last name
Address
(Required)
Street Address
City
State
Postcode
Email
(Required)
Mobile number
(Required)
Placement Details
Current place of study (University/College)
(Required)
Qualification currently studying
(Required)
Tutor Name
(Required)
Tutor Phone
(Required)
Tutor Email
(Required)
Total number of work placement hours required
(Required)
Work placement insurance document from your University/College
(Required)
Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Workplace Agreement from your University/College
(Required)
Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Preferred starting date for your work placement
MM slash DD slash YYYY
Preferred region you wish to complete your placement hours
(Required)
Please select
Mount Barker
Murray Bridge
Goolwa
Renmark
Mount Gambier
Kangaroo Island
Please provide details as to why you wish to complete your work placement with Livit Disability Support
(Required)
Qualification Information
Do you hold the following:
A current NDIS Worker Check
(Required)
Yes
No
NDIS Worker Check
(Required)
Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
A current DHS Working with Children Check
(Required)
Yes
No
DHS Working with Children Check
(Required)
Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
A current First Aid Certificate
(Required)
Yes
No
First Aid Certificate
(Required)
Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
A current CPR Certificate
(Required)
Yes
No
Current CPR Certificate
(Required)
Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
Are you willing to obtain those you answered no to at your own cost if you are offered a work placement?
(Required)
Yes
No
Declaration
(Required)
I declare my responses to this application are true and correct to the best of my knowledge.
