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Application Form
Title:
First Name(s)
Last Name(s)
Home Address
Home Telephone Number
Mobile Number
Email Address
Date of Birth:
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Unique Learner Number
National Insurance Number
Name of Parent/Guardian (if under 18)
Relationship
Contact Number
Programme Applied For
Programme Eligibility
Before we can process your application we need to verify that you are eligible for LSC funding for its Work Based Training for Young Peoples programmes. Please confirm the following (Please enter yes or n/a)
Are you a British or European (EU) National who has been resident in Britain or the European Economic Area for three years
If NO Please give details of your residence status
Are you in full time education at school or FE College
Are you in Higher Education at an HE Institute or University
Do you have a current UK National Insurance Number
Have you completed year 11 of statutory school education
It is possible we will need to contract you to clarify any issues we have to enable us to take forward your application
Education & Training
Name of school or college you last attended:
Address:
From:
To:
Name of any previous training provider/College registered with:
From:
To:
Qualifications
Please include all qualifications completed to date:
Title/Subject, Level, Grade, Year (Achieved):
Text Format
Structured Text
reStructured Text
HTML
Plain Text
Current Employement Details
Employer/Company Name
Employer/Company Address
Postcode
Telephone Number
Fax Number
Email Address
Website
Employment History
Employer/Company Name, Position, Start Date, End Date:
Equality and Diversity
(Please use the arrow to indicate your ethnic background):
Please indicate your ethnic background:
Asian/Asian British – Bangladshi
Asian/Asian British – Indian
Asian/Asian British – Pakistani
Asian/Asian British – other Asian background
Black/Black British – African
Black/Black British – Caribbean
Black/Black British – other Black background
Chinese
Mixed – White & Asian
Mixed – White and Black African
Mixed – White and Black
Caribbean
Mixed – any other background
White – British
White – Irish
White – any other background
Any other
Not known/not provided
Additional Support
(Please tick the following points that relate to you, this information is used to help us identify a suitable programme/support to meet your individual needs):
Do you have a disability or condition, which restricts the kind of work you do, or for which you will require support?
Yes
No
If yes give details
Is English your first language?
Yes
No
Will you require support with your written work?
Yes
No
Will you require support with reading?
Yes
No
Do you have any learning difficulties for which you will require support?
Yes
No
If yes give details
Are you dyslexic?
Yes
No
If yes, what support will you require?
If yes to any questions in this section, please make a note of any support provided by previous school/college/provider:
Additional Information
Please use this space to record any additional information, which you feel we should know about you:
(Please enter Yes to identify any health issues):
Asthma
Yes
No
Heart Condition
Yes
No
Diabetic
Yes
No
Difficulty standing for long periods of time
Yes
No
Difficulty sitting for long periods of time
Yes
No
Joint problems
Yes
No
Epilepsy
Yes
No
Skin conditions
Yes
No
Stress/anxiety
Yes
No
Depression
Yes
No
Migraines
Yes
No
Other
Give Details of any other health issues
Next of Kin
Please give a contact name and telephone number in case of emergency
Name
Phone:
I understand I must successfully complete a probationary period in employment, and I may have to wait for a vacant place, before I can be signed on to a Training Programme with UK Training and Development.
Please return the application form to UK Training & Development, Marlowes Business Centre, 41 The Marlowes, Hemel Hempstead, Herts, HP1 1LD
Data Protection
The information on this form will be stored on our database and maybe shared with The SFA (Skills Funding Agency) who help fund some of our training programmes.
Enter the word below
(Required)
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