Get Set for Work Referral Form CLIENT'S DETAILS Please note: Qualification / Statement of Attainment details are an essential criteria requirement for the referral to proceed. Name (in full, as printed on birth certificate) DOB Country of Birth Town of birth Address Postcode Phone Email Gender Male Female Cultural Identification Aboriginal Torres Strait Islander Australian South Sea Islander CALD-B Next of Kin Name Phone Address Postcode Referral Details Referral Agency Contact Person Position Phone Reason for Referral Organisations already linked. e.g – YJ, CHILD SAFETY, ANGLICARE etc Education Last Grade attended: Has completed a Skilling Queenslanders for Work Program before? Yes No If Yes, please provide details: Reason for leaving School: Learning Barriers (please specify) Other Details USI (Unique Student Identifier) Previous Qualifications attained or Statement of Attainment? Submit
