YEP11 Application form

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Email *

First Name *

Last Name *

Phone *

Address *

Date of Birth *

YYYY

Gender *

Female

Male

Prefer not to say

Other:

Emergency Contact - Name and Phone *

Are you currently attending school or other education/training? *

Yes

What is your highest level of education achieved? (e.g. completion of year 10) *

What qualifications do you have?

Certificate III

Certificate IV

Diploma

Degree

None of the above

Other:

Are you currently employed? *

Yes, full time (average 38 hours per week)

Yes, part time (less than 38 hours per week)

Casual (no defined hours)

Not employed

Are you registered with a Commonwealth Employment Service/Program *

Yes

Do you have an ABN? *

Yes

Do you have dependants (children) under 18 years? *

Yes

Do you identify as Aboriginal or Torres Strait Islander? *

Yes

Are you registered with NDIS?

Yes

Clear selection

What is your residency status:

Australian/New Zealand Citizen

Australian Permanent Resident

Humanitarian Visa Holder

Clear selection

What has motivated you to apply for the YEP11 youth entrepreneur program? *

What are your career goals? *

Is there anything that we could do to support your participation in the program? (e.g. childcare requirement, transport, learning difficulties, dietary requirements)

Parent/Guardian details (if under 18 years) - Name, Contact Phone, Contact Email

Please be aware that during this program you/your child may be photographed or videoed at various times. With your consent, the photos, videos, and interviews may be reproduced and released as marketing material on YEP Careers website, social media platforms and news outlets. *

I give permission for my/my child’s photographs, videos, interviews to be used by YEP Careers for media and marketing purposes.

I DO NOT give permission for my/my child’s photographs, videos, interviews to be used by YEP Careers for media and marketing purposes.

Privacy Notification and Consent Form - In order to provide employment services and assistance, the Provider (acting as a contractor of the Department of Industry) is required to collect sensitive information that is additional to personal information such as name and date of birth. This sensitive and/or health information may include details of: schooling and other educational experiences; cultural background, to ensure that you are provided with the most appropriate service or a translator if required; medical conditions, injuries or disabilities, for example to provide you with appropriate support services and/or to ensure your suitability for certain employment opportunities and activities; housing status and sustainability—this allows the provider to provide you with appropriate support services if required. Your Provider will generally collect such information directly from you; however your information may also be collected from: Service Providers and/or third parties including where work experience or voluntary work activities are undertaken. Employers offering volunteer or work experience places; Support Service Providers such as mental health services, housing and accommodation services, alcohol and other drug treatment services. I confirm that I have read, understood and agree to the collection of my sensitive personal information in accordance with this agreement form. *

I agree

The Youth Employment Innovation Challenge is a two-year program funded by the Department of Industry (DoI). At the end of the two-year period, DoI will undertake an evaluation assessing the effectiveness of the program. As part of this research, we would like to access your personal information (including sensitive information) collected by the service provider when you are registered with the provider. We are asking if you would be willing to allow us to link data from you across different government departments including Family and Community Services, Department of Justice, Department of Health and state health agencies, Department of Education, Department of Social Services and the Australian Taxation Office. This research will enable us to develop future programs best suited to the needs of young unemployed people. Note that non-participation in the program evaluation will not exclude you from accessing the program. Please indicate below if you are willing for your information to be used in the program evaluation.

Yes, I consent to my information being used for the purposes of program evaluation

Yes, I consent to my information being linked across government departments for the purposes of program evaluation.

No, I do not give consent for my information to be used in the program evaluation

Yes, I consent to my information being stored outside of Australia

Clear selection

I agree that all information contained in this form is true and correct? *

I agree

Submit

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