CCUSA Work and Travel Abroad • 901 E Street, Suite 300 • San Rafael, California 94901

USA • 1-888-449-3872 • 415-339-1832 • amyn@ccusa.com

Work Adventures Down Under Application

Dear Work Adventures Down Under Applicant:

Thank you for applying to CCUSA’s Work Adventures Down Under program to Australia and/or New Zealand. To apply, please complete and return the attached by emailing Amy Nichols (amyn@ccusa.com).

To apply, you need to return the following:

- The CCUSA application (Fillable PDF) - Two Reference Forms (Should be completed and sent to Amy directly at amyn@ccusa.com) - Signed Program Agreement (please print and sign and scan and email back) - Clear copy of Passport - Proof that you have graduated from High School (Copy of your diploma or satisfactory GED) - Application Fee of $100 (Credit Card Form attached which you can fax)

Again you can return these documents by emailing Amy Nichols (amyn@ccusa.com) or fax at 1-415-339-2744. We look forward to helping you plan your adventure down under!

Best Regards,

Amy Nichols

Program Coordinator

CCUSA

amyn@ccusa.com

1-415-275-6037

Program Applying for: (Check only one program unless you are applying for a combination program) Note: Not all programs are available in all countries.

Camp Counselors USA Work Experience USA Practical Training USA Volunteer Experience Africa Volunteer Experience Asia Camp Counselors Russia Camp Counselors Canada Work & Play Canada Volunteer Experience Latin America Work Adventures Down Under Work Exchange UK Work in English Pubs Other

Include 2 smiling

passport size photos

Use a paperclip to attach

photos: DO NOT GLUE TO

AP PLI CA TION

CCUSA Program Application

Employers will review your application thoroughly to determine eligibility for placement. Complete all sections neatly in BLACK ink or type or apply online at http://applications.ccusa.com for faster application processing. Use only the English alphabet.

Dates of Availability: (be specific) Date you can depart your home country Date you must return to your home country

Enter all information exactly as it appears on your passport

Family Name Male Female

First Middle

Date of Birth City/Town of Birth Country of Birth

Citizen of Permanent Resident of Present Occupation

Name of School/Employer: Do you have dual citizenship or passports? YES NO

If yes, which passport will you use for your visa? Passport Number

Passport Issue Place Passport Issue Date Passport Expiry Date

Have you or either of your parents ever held US Citizenship or a US Passport? YES NO

Weight kgs Height cms Do you have a Driver’s License? YES NO Do you have internet access? YES NO

Permanent postal address to be reached at all times: T-shirt Size S M L XL

Number/Street

City/Suburb State/County

Postal Code Country Email How often do you check email?

Phone Mobile Phone Work Phone

Are you married? YES NO Are you engaged to be married? YES NO Do you have children? YES NO

Emergency Contact: Name Relationship Telephone

Do you have friends/relatives in the country you are travelling to? YES NO If YES, does this person speak English? YES NO

Name Relationship Telephone

Are you a full-time student? If yes, check category: University Undergraduate Graduate Student Professional/College/Technical/TAFE Medical School

Year in Education: UNIVERSITY (1,2,3 or 4) POST GRADUATE (5,6,7 or 8) OTHER (1,2,3 or 4)

List secondary school you have attended: Dates of attendance Did you complete? YES NO

List colleges or universities you have attended (or are attending):

Name of College/University Date started Estimated Graduation Date Major course of study

Career plans Languages spoken fluently

If English is your second language, how long have you been studying it?

Describe your most recent jobs (paid or voluntary positions) Reason for leaving?

E D U C A T I O N

P E R S O N A L I N F O R M A T I O N

W O R K H I S T O R Y

Employment Confirmation:

Dates:

Program Code:

Position:

Staff Category:

Pocket Money $:

CCUSA Fee $:

OFFICE USE ONLY

Rev.16.02.12

YES NO Are you in good health? If no, explain

YES NO Any physical disabilities (past or present)? If yes, explain

YES NO Do you suffer from any pre-existing medical conditions? If yes, provide separate description.

YES NO Any allergies? If yes, specify

YES NO Are you a vegetarian or vegan? If yes, check which Vegetarian Vegan

YES NO Any special dietary needs? (special dietary needs cannot always be accommodated)

YES NO Do you consume alcoholic beverages? If yes: Daily Weekly Every 2 weeks On special occasions

YES NO Do you smoke? If yes, how often?

YES NO Most employers have smoke free environments. Are you prepared not to smoke while at work?

YES NO Are you presently or have been, in the last two years, on any medication? If yes, explain

YES NO Have you ever suffered from a nervous breakdown, depression or other emotional disorder? If yes, provide separate de scrip tion.

YES NO Are you currently or have you ever received psychiatric care? If yes, provide separate description.

YES NO Have you ever suffered from an eating disorder? If yes, provide separate description.

YES NO Have you ever had a drug addiction/problem? If yes, provide separate description.

YES NO Do you have any visible tattoos or body piercing? If yes, describe.

YES NO Are you willing to cover your tattoos and cover or remove your body piercing? If no, explain

Do you prefer to work alone or with a group? Why?

Why do you want to participate in this program?

What do you think will be your greatest challenge in working overseas and why?

Why should an employer choose you as a participant?

Tell us about your interests, hobbies or activities.

Have you ever been arrested or convicted of a criminal offense or are you at present, the subject of a criminal investigation? YES NO (If YES, a detailed ex pla na tion must be enclosed on a separate piece of paper)

Have you ever been charged with or convicted of sexual abuse or molestation? YES NONote: A criminal police background check may be required for some programs and/or required by the consulate when applying for your visa. Further

information will be given to you if you apply to these specific programs.

Please list any visas you have held in the past. Do not include the visa you will be applying for on this program.

Country Visa Name or Type Working Visa? Year Sponsor Agency Employer Name

YES NO

YES NO

YES NO

Total number of USA J1 Visas Held : Attach a separate sheet if necessary.

Have you participated on this program or a similar program with a different agency before? YES NO

If Yes, Employer / Camp Name: Position:

Are you applying to return to your Employer / Camp? YES NO If Yes, please include an invitation from your previous Employer / Camp inviting you to return.

B A C K G R O U N D C H E C K

P R E V I O U S V I S A S

R E T U R N E E I N F O R M A T I O N

M E D I C A L H I S T O R Y

Y O U R P E R S O N A L I T Y & I N T E R E S T S

How To Complete The Reference QuestionnairePlease read before completing the reverse side of this form.

Dear Sir or Madam,

The person named on the reverse side of this form has applied for our Work Adventures Down Under program to Australia and/or New Zealand. Your honest appraisal of this applicant will assist us in determining if the ap-plicant is suitable to work, travel and immerse themselves in a foreign country for up to 1 year.

The applicant must be responsible, flexible, adventurous and have a high level of moral integrity – they must be able to adapt to a different culture and way of life. Outlined below is a brief description of the program.

The Work Adventures Down Under program gives participants between the ages of 18 and 30 the opportunity to work, live and travel in Australia and/or New Zealand for up to 1 year. CCUSA’s program assists them with pre-departure support, applying for their visa, arrival support which includes setting up a bank account, job placement assistance, housing assistance, and much more.

As the referee, you need to make an objective assessment of the character and abilities of the applicant. Any additional comments, which will help us, determine the suitability of the applicant are appreciated. Your quick response is encouraged, as we are unable to proceed with the application without your reference. If you wish to share any reservations about the suitability of this applicant in private, please contact the CCUSA office.

WE CANNOT ACCEPT REFERENCES FROM FAMILY MEMBERS, RELATIVES OR FRIENDS.

Thank you!

Please return the Reference Questionnaire as soon as possible to the applicant in a sealed envelope or email amyn@ccusa.com or danaw@ccusa.com

(Application cannot be processed without your reference).

Use the space below for additional comments:

Work Adventures Down Under Reference QuestionnaireApplicant’s Name ___________________________ ID#To be completed by referee after reading the reverse side of this form. Your honest appraisal of the applicant is of the utmost importance. The information you provide is appreciated and will remain confidential. Family members and peers—please do not complete this form.

PERFORMANCE EVALUATIONPlease check the items for which you have sufficient knowledge about the applicant:

1. Integrity2. Work habits/organization3. Adaptability/flexibility4. Attitude5. Relationship with co-workers6. Leadership abilities7. Ability to work in groups8. Responsibility9. Independent and self-reliant10. Maturity11. Perseverance

Excellent Very Good Fair Not applicable good /Unable to answer

OBJECTIVE RATINGUnder each heading, check the phrase which most accurately describes the applicant:1. Ability to direct and influence others: Exceptional leadership qualities Usually successful in leading others Unreliable leadership qualities

3. Immerse themselves in a different culture for a year: Participant is open-minded and adventurous Participant may need some support but will be fine Participant will need a lot of support on the program

5. Ability to control emotions: Well balanced, good control Average ability to control emotions Poor Frequently irritated, impatient, or depressed

2. Ability to work and cooperate with others: Gets along exceptionally in groups—a team player Will cooperate in most circumstances Gives limited cooperation—better suited to solitary work

4. Ability to follow through with job assignments: Completes tasks promptly, does more than expected Completes assigned tasks at own pace Needs constant supervision to complete work

6. How would you rate the applicant as a role model Excellent Fair Very Good Poor

7. What is your relationship to this person? Teacher Coach/Tutor Priest/Minister/Rabbi Supervisor Coworker Volunteered with participant My child’s babysitter Employer8. How long have you known this applicant? 9. How do you feel this participant will be successful working, living and traveling in a foreign country? Please explain:

10. Do you feel the participant shows any signs of behavior which may impact their success on the program? Please explain:

11. Please comment on the applicant’s suitability for this program (Use separate piece of paper if necessary):

You may be contacted by CCUSA for verification of your reference for this participant.Name of Referee Signature Date Address Phone Company Position/Title Email Fax Please return this form to applicant in a sealed envelope or you can email it to amyn@ccusa.com or danaw@ccusa.com at your earliest convenience. Thank you for your evaluation!

Rev. 04.14.16

How To Complete The Reference QuestionnairePlease read before completing the reverse side of this form.

Dear Sir or Madam,

The person named on the reverse side of this form has applied for our Work Adventures Down Under program to Australia and/or New Zealand. Your honest appraisal of this applicant will assist us in determining if the ap-plicant is suitable to work, travel and immerse themselves in a foreign country for up to 1 year.

The applicant must be responsible, flexible, adventurous and have a high level of moral integrity – they must be able to adapt to a different culture and way of life. Outlined below is a brief description of the program.

The Work Adventures Down Under program gives participants between the ages of 18 and 30 the opportunity to work, live and travel in Australia and/or New Zealand for up to 1 year. CCUSA’s program assists them with pre-departure support, applying for their visa, arrival support which includes setting up a bank account, job placement assistance, housing assistance, and much more.

As the referee, you need to make an objective assessment of the character and abilities of the applicant. Any additional comments, which will help us, determine the suitability of the applicant are appreciated. Your quick response is encouraged, as we are unable to proceed with the application without your reference. If you wish to share any reservations about the suitability of this applicant in private, please contact the CCUSA office.

WE CANNOT ACCEPT REFERENCES FROM FAMILY MEMBERS, RELATIVES OR FRIENDS.

Thank you!

Please return the Reference Questionnaire as soon as possible to the applicant in a sealed envelope or email amyn@ccusa.com or danaw@ccusa.com

(Application cannot be processed without your reference).

Use the space below for additional comments:

Work Adventures Down Under Reference QuestionnaireApplicant’s Name ___________________________ ID#To be completed by referee after reading the reverse side of this form. Your honest appraisal of the applicant is of the utmost importance. The information you provide is appreciated and will remain confidential. Family members and peers—please do not complete this form.

PERFORMANCE EVALUATIONPlease check the items for which you have sufficient knowledge about the applicant:

1. Integrity2. Work habits/organization3. Adaptability/flexibility4. Attitude5. Relationship with co-workers6. Leadership abilities7. Ability to work in groups8. Responsibility9. Independent and self-reliant10. Maturity11. Perseverance

Excellent Very Good Fair Not applicable good /Unable to answer

OBJECTIVE RATINGUnder each heading, check the phrase which most accurately describes the applicant:1. Ability to direct and influence others: Exceptional leadership qualities Usually successful in leading others Unreliable leadership qualities

3. Immerse themselves in a different culture for a year: Participant is open-minded and adventurous Participant may need some support but will be fine Participant will need a lot of support on the program

5. Ability to control emotions: Well balanced, good control Average ability to control emotions Poor Frequently irritated, impatient, or depressed

2. Ability to work and cooperate with others: Gets along exceptionally in groups—a team player Will cooperate in most circumstances Gives limited cooperation—better suited to solitary work

4. Ability to follow through with job assignments: Completes tasks promptly, does more than expected Completes assigned tasks at own pace Needs constant supervision to complete work

6. How would you rate the applicant as a role model Excellent Fair Very Good Poor

7. What is your relationship to this person? Teacher Coach/Tutor Priest/Minister/Rabbi Supervisor Coworker Volunteered with participant My child’s babysitter Employer8. How long have you known this applicant? 9. How do you feel this participant will be successful working, living and traveling in a foreign country? Please explain:

10. Do you feel the participant shows any signs of behavior which may impact their success on the program? Please explain:

11. Please comment on the applicant’s suitability for this program (Use separate piece of paper if necessary):

You may be contacted by CCUSA for verification of your reference for this participant.Name of Referee Signature Date Address Phone Company Position/Title Email Fax Please return this form to applicant in a sealed envelope or you can email it to amyn@ccusa.com or danaw@ccusa.com at your earliest convenience. Thank you for your evaluation!

Rev. 04.14.16

2016 Work Adventures Down Under USA Program Agreement – United States & Canada

This agreement is between CCUSA Inc., WTC (Work & Travel Company) and

CCUSA ID # (print name) you, a CCUSA participant

Page 1 of 5

Application and Acceptance 1.   To apply to the Work Adventures Down Under program you will be required to pay Program Fees (all payments should be made out to

CCUSA): Program Fees All program fees are to be paid in US dollars. For Canadian citizens, the fees can be paid by credit card or money order in US dollars.

1. Application Fee: US$100. This non-refundable fee must be paid when you submit your online application form to CCUSA. 2. Acceptance Fee: The fee will depend on the program options you choose below. The acceptance payment is due no later than 4 weeks in advance of your proposed departure date.

a. Australia Basic Down Under: US$650 b. Australia Essential Sydney Package: US$895 c. New Zealand Basic Down Under: US$650

3. Additional Add On Options (Packages you can add on to the above options): a. 5 Day Learn to Surf Camp Australia: US$500 b. 7 Day Learn to Surf Camp Australia: US$695 c. 10 Day Learn to Surf Camp Australia: US$845 d. Dive – Live Aboard Dive Trip Great Barrier Reef Australia (3 days/2 nights on board a boat): US$675 e. Dive – Live Aboard Dive Trip Cairns Australia (5 days/4 nights on board a boat): US$895 f. Outback/Ranch Training Course Australia: US$795 g. Bridge Climb New Zealand: US$125 h. Bay of Islands Tour New Zealand: US$195

2.   The CCUSA/WTC Program Agreement must be signed at the time of application. 3.   For Australia and New Zealand all applicants must be 18-30 years of age. US and Canadian applicants can apply for a 12 months Working

Holiday Visa prior to turning 31 years old. 4.   The program has a 99% acceptance rate. In the rare case that your application is not accepted, a refund less the $100 application fee will be

made. 5.   Your application form and references are legal documents. You agree that you have personally completed the application form and any false,

misleading or withheld information on your application or inappropriate behavior during your interview, on social media sites, prior to departure or during your participation on the CCUSA program, is grounds for immediate cancellation from the program without refund. You are required to inform CCUSA of any changes in information provided within your initial application, including but not limited to: health conditions, availability dates, skills and contact details.

6.   To apply to the program, you will be required to submit a completed application form, 2 CCUSA reference questionnaires, a passport photo, a copy of your passport (needs to be valid for 6 months after your return) proof of funds in the amount of AU$5000, all required fees and this signed Program Agreement. All materials submitted to CCUSA immediately become the property of CCUSA.

7.   CCUSA will conduct an interview to help you better understand the program and to assess your skills and experience. The CCUSA head office in the US determines final program acceptance of applicants.

8.   Upon acceptance to the program, you will receive official written notification including the appropriate visa application forms. You will be required to complete a FBI Backgrond Check and a Health History Check prior to departure.

9.   While participating on the CCUSA program you are required to check your online CCUSA account regularly and provide CCUSA with a current email address that you will access at least twice a week from the time of application through the time you complete your trip to the U.S. CCUSA will not be held responsible for problems arising from failure to check your email regularly (including junk mail) or failure to notify CCUSA of changes to your email address. You may not use a university or school email account. You are required to create a personal web-based email account once you are accepted to the CCUSA program.

10.   You, the applicant, are the only person CCUSA will liaise with in terms of your application/placement. CCUSA will not provide information about your application or program participation to parents/friends/other family, unless you are involved in a medical emergency while in Australia/New Zealand, in which case we will contact the person you have listed on your CCUSA application form as your “emergency contact.”

11.   Program deposit, insurance fee, completed visa application, proof of funds documentation and your proposed flight itinerary are due no later than four weeks in advance of your proposed departure date. Upon receipt of your program and insurance fees, CCUSA will assist you top apply for the appropriate visa. For Australia the 462-visa fee is US$349 (subject to change) and for New Zealand the visa fee is NZD$208 (both fees need to be paid at the time CCUSA lodges your visa applications).

12.   CCUSA’s preferred travel agent will be able to assist you with a variety of flights; however the price will vary depending on routing, dates and conditions. It is not mandatory to take a group flight or use our preferred travel agent services.

13.   Your visa dates will be set by the Australian and/or New Zealand Consulate based on the dates of your proposed travel itinerary and cannot be changed.

2016 Work Adventures Down Under USA Program Agreement – United States & Canada

This agreement is between CCUSA Inc., WTC (Work & Travel Company) and

CCUSA ID # (print name) you, a CCUSA participant

Page 2 of 5

Program Options Australia a.   Australia Basic Down Under Program options include the following services:

•   Assistance with and processing of your visa paperwork •   CCUSA/WTC International handbook and reference guide – what to expect from your Working Holiday Pre-Departure support •   Access to Online Job Board prior to arrival •   Low cost flight options into various Australian and New Zealand cities through our preferred travel agent •   Arrival into Sydney or Melbourne with use of both offices •   Airport pick up and transfer to hostel with priority check-in at hostel •   3 nights lodging at a hostel with breakfast •   12 month WTC membership with full access to our members only recruitment agency and online job database •   Job placement with our fully integrated in-house recruitment agency – wages paid into Aussie bank account •   Email job updates and ongoing resume review plus loan/sale of work safety equipment/clothing for work •   Longer term accommodation – help finding an apartment, hostel or shared house •   Banking information provided prior to arrival with bank account set up and MasterCard debit card upon arrival •   Registration for Australian Tax File Number •   Private mailbox with mail holding and forwarding anywhere in Australia •   Free internet in our Sydney Center as well as 15 locations around the country •   Toll free emergency assistance number – Australia wide 24/7 – accessible for full duration of WTC Membership •   Tax expert to provide advice and information about tax and superannuation refunds •   Best price guarantee from our in-house travel shop plus member’s only discounts, offers and regular travel talks •   Free city tour, beach walk, pub crawl, and drink vouchers plus one hour free internet per night booked while staying at hostel •   Monthly social activities program •   Free Harvest guidebook and 2nd work visa information pack •   Free use of phone in the office for job and general inquiries and free fax and photocopying and scanning •   WTC Ice Breaker Welcome drinks – 2 free drinks and snacks - held every week and members can attend as many times as they

want •   Welcome kit including WTC merchandise •   Aussie SIM card •   Travel insurance required for an additional fee

b.   Australia Essential Sydney Down Under Program options include the following services: •   Includes everything in the Australia Basic Down Under Program above, •   7 nights lodging at a hostel with breakfast (instead of 3 above) •   7 fun filled days of activities, including welcome lunch at Sydney Tower, paddle boarding, Tour of Blue Mountains & Featherdale

Wildlife Park, Bondi to Coogee Beach Walk and BBQ, WTC Pub Crawl, Sydney Wildlife World Tour and a city walk tour Start dates of this package are set monthly as follows: 4th April; 9th May; 20th June; 4th July; 15th August; 5th and 19th September; 17th October; 14th November; 5th December

c.   5 Day Learn to Surf Camp includes: •   Departs Sydney on Mondays from Wake-Up Hostel •   5-Day progressive Learn-to-Surf course for absolute beginners •   All surfing equipment – rip curl wetsuits and surfboards •   4 nights modern beachside accommodation at our Surf Camp •   All meals •   Return transportation from Sydney (2 hour journey each way) •   Free Rip Curl/Surf Camp T-shirt & Sunscreen •   Photos

d.   7 Day Learn to Surf Camp includes: •   Includes everything from the 5 Day Learn to Surf Camp above •   After 5 day course members return to Sydney on Friday afternoon/evening you will be taken to Byron Bay where you will spend

the weekend surfing. You can stay in Byron or return to Sydney at your own cost e.   10 Day Learn to Surf Camp includes:

•   Includes everything from the 5 Day Learn to Surf Camp above •   After 5 day course members return to Sydney on Friday afternoon/evening you will be taken to Byron Bay to finish the course •   You can stay in Byron or return to Sydney at your own cost

f.   Dive –Live aboard Dive Trip Great Barrier Reef (3 days/2 nights) includes: •   Includes 3 day, 2 nights live aboard a boat •   2 nights accommodation on board vessel in twin berth cabin (bedding supplied)

2016 Work Adventures Down Under USA Program Agreement – United States & Canada

This agreement is between CCUSA Inc., WTC (Work & Travel Company) and

CCUSA ID # (print name) you, a CCUSA participant

Page 3 of 5

•   All meals while on board boat •   Use of all equipment •   Up to 11 dives including 2 night dives •   Unlimited snorkeling

g.   Dive- Live aboard Dive Trip Cairns (5 days/4 nights) includes: •   PADI 5 day learn to dive course for 5 days/4 nights •   Course in Cairns, transportation from Sydney to Cairns is not included •   PADI Gold Open Water Certification •   PADI Open Water manual, dive log book and all stationary •   2 passport photos (must bring with you to Australia, needed for certification) •   9 dives (4 training dives and 5 pleasure dives – includes 1 night dive) •   Accommodation transfers •   All dive equipment (includes wetsuit, dive computer and torches) •   On board vessel only – all meals, twin shared accommodation – includes bed linen •   Dive insurance

h.   Outback/Ranch Training Course includes: •   Taught all the skills you need to live and work on a farm from sheep shearing and cattle mustering to fencing, riding, tractor and

quad bike driving, milking cows, using farm tools which can be utilized to getting a job working on a farm •   Action packed 5 days of farm training •   All food and accommodation for 5 days in hostel style accommodation •   Transport to the farm from Sydney •   Amazing outback experience with a job assistance at the end of the course so you can put your skills to good use

Program Options New Zealand:

i.   New Zealand Basic Down Under Program option includes: •   Pre-Departure support including assistance with processing of your visa paperwork •   CCUSA/IEP international handbook and reference guide •   Low cost flight options into various New Zealand cities through our preferred travel agent •   Airport pick up and transfer to hostel •   3 nights lodging at a hostel with breakfast •   Welcome and Orientation in our Auckland office •   Job service and placement for 12 months •   Information provided about setting up a bank account in New Zealand •   Private mailbox with mail holding and forwarding anywhere in New Zealand •   Free internet in our Auckland office •   Free emergency assistance •   Monthly social activities program •   Travel insurance required for an additional fee

j.   Bride Climb New Zealand includes: •   Tour Guide access to the Auckland Harbor Bridge and all equipment

k.   Bay Island Tour includes: •   Discover the beautiful Bay of Islands (aka Northland) •   In the summer enjoy a relaxing afternoon in sunny bay, snorkeling at the Goat Island Marine Reserve •   Transportation

Insurance 1.   CCUSA participants must purchase CCUSA insurance coverage for the full length of their program. 2.   An insurance premium of US$3.55 per day (Economy coverage) or US$4.30 per day (Premium coverage) is due 30 days prior to your

departure. Prices correct at time of print, are subject to change. 3.   If you are traveling before or staying longer, you will need to purchase additional insurance. Extensions can be done by calling CCUSA, but will

have to be done before your insurance expires and are at the discretion of the insurance company. 4.   The policy includes: accident, sickness, medical evacuation (see insurance brochure for full details on the policy). 5.   The insurance plans do not cover baggage, pre-existing medical conditions, dental, or auto insurance. 6.   In case of an accident or incident, it is your responsibility to submit a claim form with all original documentation and/or follow the procedures

set out by the insurance company. 7.   CCUSA is not the insurance company. All claims, processing, and queries are between you and the insurance company. You will receive a

2016 Work Adventures Down Under USA Program Agreement – United States & Canada

This agreement is between CCUSA Inc., WTC (Work & Travel Company) and

CCUSA ID # (print name) you, a CCUSA participant

Page 4 of 5

copy of the policy once you have been accepted to the program. Be sure to read all policy details via your online CCUSA account. 8.   You will receive a copy of the policy and an insurance ID card, once you have paid for your insurance. Be sure to read this for complete

policy details and keep the insurance ID card with you at all times while you travel. Criminal Background Check 1.   To participate on the CCUSA program, you must apply for a current criminal/police background check within 2 weeks of acceptance by the

CCUSA head office. 2.   As part of the application you are required to disclose to CCUSA any and all criminal history, criminal offense, arrests, charges, or

sentencing. You will also be required to get a Federal Police Background check. Any criminal history reflected in this background check could affect acceptance/placement opportunities and/or result in loss of placement. Once the background check has been processed, you must submit the report to CCUSA at least 4 weeks before your program start date. Therefore, this may require an expedited background check to ensure receipt at least 4 weeks prior to start date.

3.   If you are not a citizen or permanent resident of the country from which you are applying, you must also gain a criminal/police background check from your home country as well with an English translation.

Medical History 1.   As part of the application you are required to disclose to CCUSA any and all past or current medical conditions (if you are unsure of

what to include contact CCUSA to discuss). 2.   If accepted, you must download the CCUSA Health History form, which must be completed and signed by your physician. This must be

completed per the instructions and submitted to CCUSA at least 4 weeks prior to departure. 3.   Some programs require specific inoculations. If so, those requirements will be indicated in your placement information. Please note you

should get these inoculations before your departure.

Refund Policy 1.   If you cancel from the program after your CCUSA interview and prior to your acceptance to the program, you will be refunded the program

fees, paid less the non-refundable application fee of US$100 (administration costs). 2.   The application and acceptance fees will not be refunded if you cancel from the CCUSA program after acceptance (unless canceling for

reasons outlined in Point 4). If you have not paid your fees in full, you will be invoiced for the amount due to CCUSA which are due within 14 days of cancelling.

3.   If you change any information on your application after acceptance to the program that CCUSA determines will adversely affect your program, CCUSA reserves the right to withdraw your application from the program; in this case there is no refund of any fees. This includes information you post in your application documents as well as any information that you post on the internet or social media.

4.   If you cancel due to life-threatening illness or a life-threatening illness or death of a parent or sibling (medical certificate required for review by CCUSA), you will receive a refund of your Acceptance fee. You will be charged for any flight cancellation fees if applicable. A written cancellation notification and the medical certificate documenting the illness must be received within 10 days of cancelling to qualify for a refund. No refunds will be made for cancellations as a result of pre-existing conditions.

5.   If the Australian or New Zealand government denies your visa, the program deposit and insurance payment less US$100 administration fee will be refunded. You will be responsible for any flight ticket cancellation charges. CCUSA cannot be held responsible if your visa is rejected.

6.   Fees incurred for obtaining your criminal background check, medical examination and visa processing and any other third party services are non-refundable in most cases and CCUSA is not responsible for any refunds of these fees.

Post Program Travel You are responsible for travel costs including transportation, meals and accommodation. This includes travel costs to your U.S. departure airport for your return flight home or onward international travel.

During Your Program 1.   For “Ultimate Packages” only: WTC provides you with membership of Exclusive Job Search Team with a team of staff in Sydney working on

finding a job for you, plus an accommodation finding service. In Auckland you receive membership to the “Travel Lounge”, which is a members internet site giving you access to jobs, accommodation and ride-share information plus the guarantee of at least one job offer during your stay in New Zealand. The CCUSA/WTC International handbook provides you with the resources to secure a job prior to your departure to Australia/New Zealand.

2.   With the exception of the first 3 nights hostel accommodation for Basic packages to Australia and New Zealand or 7 nights for the Ultimate Sydney package, you are fully responsible for room and board during the full duration of your stay Down Under.

3.   Your pesonal expenses during the program are your own responsibility. 4.   You are required to keep CCUSA/WTC informed about your job search and to update CCUSA/WTC on your contact address and phone

number. This is needed for emergencies and program supervision. 5.   You are required to extend your insurance before the date of expiration, however all extensions are at the discretion of the insurance

company. 6.   In Australia, mail is forwarded to participants on a monthly basis provided the participant contacts our Sydney office with an address where

mail can be forwarded to for at least 2 weeks.

2016 Work Adventures Down Under USA Program Agreement – United States & Canada

This agreement is between CCUSA Inc., WTC (Work & Travel Company) and

CCUSA ID # (print name) you, a CCUSA participant

Page 5 of 5

7.   For US and Canadian Citizens the maximum length of stay in Australia is 12 months and for New Zealand it is 12 months as well. If you

combine Australia and New Zealand then it can be 24 months.

I certify that I will be at least 18 years of age by June 1st, 2016 and I personally completed the CCUSA application form. I understand that I sacrifice privacy and comfort, work long and demanding hours and must adhere to camp policies which may be limiting and not necessarily reflect my way of living (curfews, time on/off, no smoking, no alcohol, etc.).

My signature below confirms that I have read, understood, and agreed to abide by the terms, conditions and rules as detailed above. I agree that all information written and given to CCUSA is 100% correct. I allow CCUSA to send me program information and updates via email. I also allow CCUSA to forward my name, email address and postal address to its preferred travel agent, to other participants, who may wish to share a room for any travel options and to participants placed at the same camp or traveling on the same flight. I allow photos taken of me at meetings, arrival sites and/or at WTC or IEP Offices to be used for publicity purposes. California law applies to any disputes arising out of this agreement. Name: ____________________________________________ Signature: ___________________________________ Date: __ / /

If you are under 18 years of age at time of applying, your parent / legal guardian will be required to co-sign this program agreement below.

Name: ____________________________________________ Signature: ___________________________________ Date: __ / /

Please make a copy of this for your own records and return the signed copy to your local CCUSA Office by fax: 1-415-339-2744 or by email to: AmyN@ccusa.com

For Office Use Only

Submitted by: Date:

Processed by: Date:

Paid Declined Incomplete Information

Credit Card Authorization Form

Please write CLEARLY and complete all sections:

Amount to be charged in USD: $Your Name: CCUSA ID #:

Employer/Camp Name:

Email Address

Type of Card (check one): VISA MASTERCARD AMEX DISCOVER

Name as it appears on credit card:

Credit Card Billing Address:

(don’t forget postal code and country)

Please call CCUSA at 1-888-449-3872 to provide us with your Credit Card number. Please DO NOT write it on this form as it is not a secure way to send your information. Thank you.

Purpose of charge:

I hereby authorize CCUSA to charge the above credit card for the amount listed.

Signature of Card Holder: Date: (type or sign)

Please return the completed form to CCUSA via fax or email.

CCUSA World Headquarters, 901 E Street, Suite 300, San Rafael, CA 94901Camp Counselors USA: 1-415-339-2728 or toll free 1-800-999-2267Work Experience USA: 1-415-339-2740 or toll free 1-888-449-3872

Fax: 1-415-339-2744 or Email: info@ccusa.com