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Citipointe Internship Academy Application Form
Please read each question carefully, answer truthfully and be yourself.
Please choose which intake are you applying to do the Citipointe Internship Academy? *
What are your Given Name(s)? *
What is your Surname? *
What is your address? *
What is your mobile number? *
Include Country Code - ie. Australia is +61
What is your date of birth? *
What is your email address? *
What is your Gender? *
Do you have any medical condition(s) that you would need to make Citipointe Church aware of? *
Eg. Diabetes, heart condition, mental health etc.
Please indicate the country you are a citizen of: *
Do you have a current "Working with Children Check" (Blue Card)? *
For more information please visit
If you answered Yes to having a "Working with Children Check" (Blue Card), Please provide your card details.
Card number and expiry date
If you answered No to having a "Working with Children Check" (Blue Card), Please tick the option that best describes your situation?
Do you have a Drivers License? *
This question is pertaining to having your provisional License ("P's") or above. If you have your Learners please select "No"
If you answered Yes to having a drivers license, Please provide the details of what type of license you have? *
Opens, P's, Heavy or Medium Ridged etc. Please do not disclose your license number.
Do you have a criminal conviction? *
If yes, please provide some details by emailing
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