Personal Details
First Name: Family Name: Date of Birth: Male/Female
Nationality: Passport Number: Date of Expiry:
Correspondence Address:
Tel No: Country Code: Area Code: Number:
Mobile No: Email:
Education
University / School attended:
Course / Degree:
Number of Years Attended:
Date of Graduation:
Work Experience
Work Experience:
Skills and Qualifications
Do you have a Driver’s Licence? Can you drive a car with a manual gearbox?
Can you ride /drive a Motorbike? Tractor? Truck?
Can you ride a horse? How well? Beginner : Intermediate: Advanced:
Do you have any mechanical skills? Can you weld?
Other skills, qualifications:
Dietary, Medical & Personal
Any special dietary requirements?
Are you undergoing any sort of medical treatment, including medication?
Is your anti tetanus protection in date?
Do you have any physical limitations?
Do you Smoke? Shoe Size:
Will you provide your own health and accident insurance letter to accompany your Visa application? YES / NO
Will you wish to join the Visitoz health insurance policy? $2 per day. YES / NO
(An insurance certificate has to accompany the visa application. This insurance is payable only
when the arrival date in Australia is known – after the Grant of the Visa.)
Next section to be signed by all Intership candidates
I understand that I cannot go to a job of my own choosing in Australia. Signed:
I understand that I cannot leave a job in Australia without first informing Visitoz. Signed:
I understand that I cannot accept a job in Australia without first informing Visitoz. Signed:
I understand that I cannot take a job with a non Visitoz employer. Signed:
I understand I will travel on a return ticket and inform Visitoz of the date and time of the return Signed:
I understand that I must inform Visitoz if I take a short holiday from my job. Signed:
I understand that if I overstay I (or my parents) could be fined by the Immigration Department. Signed:
I understand that if I am sponsored to stay in Australia that I will inform Visitoz and
Will give details of my employer, the date the new visa starts and the category of visa Signed:
I understand that if there are any inaccuracies in this or my visa application I will be responsible
And I will lose my Deposit and Bond. Signed:
I understand that if I complete all the requirements of Visitoz and the Government of
Australia the $1000 Bond will be returned to me on leaving the country Signed:
Additional information:
The Internship fees include the Visa fee, the deposit, the bond and the programme fee. The bond is returnable.
Packages
PlPlease indicate which Programme you are wishing to participate in / Agricultural Programme / Hospitality
Volunteer
$2399
YES / NO / Internship
$5499
YES / NO / Volunteer
$2399
YES / NO / Internship
$5499
Preferred Start Date (Thursday):
Declaration / I agree that I will purchase a return air ticket and will use this air ticket to and from Australia in connection with this programme . I agree I will not stay in Australia after my visa has expired, if I do I agree I will be liable for any charges of the Department of Immigration.
I have read the information provided to me by Visitoz and I hereby apply to join Visitoz. I agree to pay the deposit now $1370 and the balance of the fee for the package that I have indicated when the visa is granted. I will book my own air ticket and will bring with me my driving licence, Insurance and medical card/certificate. I understand that farm work can be dangerous and will not hold Visitoz liable for any accident to me, however caused. I will inform Visitoz of my flight number and arrival time and will try to arrange a Thursday morning arrival at Brisbane Airport. International Terminal. I agree that if photographed while at Visitoz my picture may be included in Facebook or web site pages.
Credit Card details for Payment: This card is for the initial payment of $1370 and when the visa is granted for the balance of $4129 plus the insurance at $2 per day when the exact arrival date is known. Visa and MasterCard only please.
Card Numbers ………./ ………. / ………. / ………. Expiry date ………. / ………. CCV (last three numbers on the back) ………
Signature: Date:
Parent Full Name and address
Any other information?