Surname *

Forenames (as shown on your passport)*

Name as you would like to be known *

Address1 *

Address line 2

Town/City *

County *

Country *

Postcode *

Telephone *

Mobile *

Email *

Date of Birth * dd 12345678910111213141516171819202122232425262728293031 / mm 123456789101112 / 19 yy 96 95 94 939291908988878685848382818079787776757473727170 69 68 67 66 65 64 63 62 61 60

Age at time of Departure *

Parent/Guardian/Next of Kin

Full Name (including title)*

Daytime tel number*

Address1 *

Address line 2

Town/City *

County *

Country *

Postcode *

Relationship to you *

Nationality

Nationality *

Passport Number *

Date of Expiry *

Name of Most Recent Educational Institute

School/College/University*

Address Line 1*

Address Line 2

Town*

County*

Postcode*

What qualifications have you already gained?

GCSE´s / Scottish Standard Grade / Equivalent

A Levels / Scottish Highers / Equivalent

Degree / Equivalent

List any paid jobs you have had
(including job title and dates)

What are your plans after your year out?

Go to university Choose Yes No

Go in to a career Choose Yes No

Other (please state below) Choose Yes No

Other

Can you speak another language? (please state)

To what standard do you speak the language?

Do You Have A Drivers License? Choose Yes No

Can You Drive A Manual Car? Choose Yes No

Can You Ride A Motor Bike? Choose Yes No

Can You Drive A Tractor? Choose Yes No

Can You Drive A Truck? Choose Yes No

How Well Can You Rise A Horse? I Can't Beginner Intermediate Advanced

Do You Have Any Mechanical Skills? Choose Yes No

Can You Weld? Choose Yes No

List any other skills or qualifications

Any special dietry requirements?

Are you undergoing any special sort of medical treatment.

Is your anti tetanus protection in date.

Do you have any physical limitations.

Do you smoke? Choose Yes No

Do you wish to train with a friend. Who?

Do you wish to work with a friend. Who?

Please tell us about yourself, your travelling and other relevant experience and your reasons for travelling to Australia?

Why have you chosen farm work in the Outback rather than work in the city”

What will you enjoy about working on a farm in the Outback?

What will you find difficult about working on a farm in the Outback?

Please let us know when you would like to begin this program?

Why would you like to go away with us.

How did you hear about us?* Via Gapyear.com Seasonworkers.com The Big Issue Gapyeardirectory.com Bestskijobs.com Year out group Family & Friends Talk at school Gap Year Guide book Notgoingtouni.co.uk Referred by another organisation Information from Careers service Teacher at school Knowing returned volunteer Responsible travel Net surfing Other

Any additional information:

Your Payment:

As part of your application, we require you to pay the first £50.00 of the program fee. After interview, if we were unable to offer a place, we would return this £50.00 to you. Please enter your details below and note that if you choose to use a Credit Card, you will be charged a 2.25% service charge (£51.13 total).