Work Experience – Own Find Form

Student Name: / Student Contact Number:
School: / Placement Dates:

To be completed by the EMPLOYER/ORGANISATION in CAPITALS & USE BLACK INK

Company Name: / Contact Name:
Contact’s Position:
Company Address:
Post Code:
Phone Number: / Email:
Type of Business:
If you have taken work experience students before, please give details of the school or local Authority who arranged it and/or visited your premises to carry out a pre-placement check.
(we may NOT need to carry out another check if you can provide this information)
Organisation name:
(School, Local Authority, EBP etc.)
Address or contact number (if known):
New to Work Experience? / I am happy to undergo a pre placement assessment visit : YES NO
(If No, placement will not be able to go ahead)
Barnet EBP will endeavour to visit prior to the placement. If after 5 attempts to arrange the visit we have been unsuccessful, the placement cannot be approved.
The employer must hold Employer’s Liability Compulsory Insurance*. The certificate must be held at each place of business where the policy holder employs persons covered by the policy. (Our officer will ask to see this certificate). We would ask you to contact your insurers in advance of our visit to confirm that cover is available for ‘students of school age on un-paid, school approved work experience’ .This should not incur any additional premium.
NAME OF EMPLOYERS LIABILITY INSURANCE COMPANY / (PLEASE ATTACH A COPY OF YOUR EMPLOYERS LIABILITY INSURANCE CERTIFICATE)
POLICY NO / EXPIRY DATE
Are your premises registered with either of the following: Health & Safety Executive Local Authority
Do you have 5 or more
Do you have 5 or more employees (inc.work experience student): YES NO
If Yes (a): Do you have a written Health & Safety Policy : YES NO
(b): Do you have written Risk Assessments: YES NO
(c): Do you have Young Person’s Risk Assessments: YES NO
Are you a “One-person business”: YES NO

PTO

Please give us some information about the students role:
Job Title:
Job Description:
Hours of work:
Dress Code:
Will the student be travelling around to various sites/locations?
Do you help students with their meal or transport costs?

Please confirm your offer of a Work Experience placement (Manager or Supervisor should sign below):

For & on behalf of (COMPANY NAME): ______

Signed: ______Position:______

PRINT NAME: ______Date: ______

Work experience offers the pupils of today the opportunity to prepare for the challenges of tomorrow. It will enable them to become familiar with the skills and attitudes which modern business requires of its workforce. There are few better ways of preparing today’s youngsters for adulthood and working life.

Safety, Preparation and Learning by Doing are the cornerstones of this programme.

Thank You for supporting our Young People J