
 
1 
       
Work Experience Reference Form  T703-1 
 
Work Experience Reference 
Applicants should read in full the 
APC Work Experience Template Explanatory Notes
 located on page 3 of 
this form prior to completing this form.  
Note that all fields in this form must be completed, failure to complete this form correctly will result in a 
delay of the assessment process.  
This form must be signed to be considered valid. 
 
Applicant details 
First name 
 
Last name 
 
Other name/s 
 
Date of Birth  
__ __ / __ __ / __ __ __ __ 
(dd / mm / yyyy format) 
 
 
Employer/Referee details 
Title  
 
(Mr, Ms, etc.) 
First name 
 
Last name 
 
Job Title 
 
Organisation name 
 
Official organisation 
address 
 
Official organisation 
email address 
 
Official organisation 
phone number(s) 
 
Professional relationship 
to applicant 
 
(eg.  manager, supervisor, head of 
department, etc.) 
Applicant’s job title 
 
Applicant’s employment 
start date  
__ __ / __ __ / __ __ __ __ 
(dd / mm / yyyy format) 
Applicant’s employment 
finish date 
__ __ / __ __ / __ __ __ __ 
(dd / mm / yyyy format) 
Applicant worked 
Full time (20+ hours per 
week) 
 
Part time (less than 
20 hours per week)