Apprenticeship Application Form

Apprenticeship Application Form

Thank you for considering an apprenticeship with Southend Adult Community College. Please complete this form and contact if you have any queries.

PLEASE NOTE THAT ONLY SUCCESSFUL APPLICANTS WILL BE CONTACTED DUE TO THE HIGH VOLUME OF APPLICATIONS BEING RECEIVED

Personal information

Full Name:
Title: /
All Previous Names:
Address:
Postcode:
If at this address less than 3 years please provide us with your previous address:
Home Telephone Number:
Mobile:
Email address:
Emergency Contact Name and Telephone Number:
Date of Birth:
(format dd/mm/yyyy)
Age:
National Insurance Number:
Current employment status:
If you are employed, how long have you been employed for, and how many hours a week do you work?
If you are currently unemployed:
How long have you been unemployed for?
If you are currently unemployed:
Which benefit do you receive?
FOR OFFICE USE ONLY:
Employer Details
Fee information: / FREE

Personal Statement

We would like you to write a personal statement about yourself (maximum 500 words) to help us understand a little more about you.

You should include the following information:
·  Why you want this apprenticeship
·  What skills you have that are relevant
·  What experience you have that may be relevant for example part time work, work experience and voluntary and community work
·  Your interests and hobbies

Your Qualifications

What is the highest qualification (or equivalent) you hold?

Please indicate what qualifications you have completed in the past, or are currently undertaking. If you have no qualifications please state “NONE”.

Type of qualification, eg GCSE or NVQ.
Include qualifications taken outside of UK / Subject / Level/GradeAchieved / Date qualification completed

Unique Learner Number

Southend Adult Community College would like to ask your permission to access your Unique Learner Number (ULN) and associated records. By accessing your ULN the college will gain access to the certificates for all qualifications you currently hold.

Please select this box to confirm you understand and give your permission ☐

Work Experience

Date From:
To: / Name and address of current/most recent Employer:
Reason for leaving or seeking other employment:
Job title:
Description of duties:
Period of notice required:
Current salary:
Date From:
To: / Name and address of employer:
Reason for leaving:
Date From:
To: / Name and address of employer:
Reason for leaving:
Date From:
To: / Name and address of employer:
Reason for leaving:

References

Your present employer should be one referee. However, if you are not employed at the present time, please give a past employer as a referee. (We reserve the right to contact any of your previous employers for a reference if an offer of employment has been made to you or is contemplated. Relatives are not acceptable, even if they are your employer).

First Reference

Title
Name
Job Title
Address
Postcode
Email address
Work phone number

Second Reference

Title
Name
Job Title
Address
Postcode
Email address
Work phone number

Disclosure of Criminal Convictions (Spent and Unspent)

Please read these notes carefully and then enter any convictions in the box below, continue on a separate sheet if necessary. If you have no convictions, please enter “none”.

Offence / Date of Conviction / Sentence

1.  Please remember that a “conviction” includes

(a)  a sentence of imprisonment, youth custody or borstal training

(b)  an absolute discharge, conditional discharge, bind over;

(c)  a fit person order, a supervision or care order, a probation order or an approved school order arising from a criminal conviction;

(d)  simple dismissal from the Armed Forces, cashiering, discharge with ignominy, dismissal with disgrace or detention by the Armed Forces;

(e)  detention by direction of the Home Secretary;

(f)  detention centre, remand home, or attendance centre orders;

(g)  a suspended sentence;

(h)  a fine or any other sentence not mentioned above.

2.  I certify that, to the best of my belief, the information I have entered is factually correct and I understand that any false information may, in the event of employment, lead to disciplinary action which could result in dismissal.

Household Situation - Please tick which of the following statements apply (one or more may apply)
No member of the household in which I live (including myself) is employed / £
The household that I live in includes only one adult (aged 18 or over) / £
There are one or more dependent children (aged 0-17 years or 18-24 years if full time student or inactive) in the household / £
None of these statements apply / £
I confirm that I wish to withhold this information / £

Equality and Diversity

Do you describe yourself as having a disability in accordance with the Disability Discrimination Act?

Yes No

Do you have any special requirements that we need to know about in order to receive a fair interview?

Yes No If yes, please contact

The College is committed to ensuring equality for all current and potential students irrespective of disability, age, race, gender, special educational needs, religion, sexual orientation, marital status or learning difficulty. To enable the SFA/EFA to ensure that we are providing education and training for all, regardless of any disability or learning difficulty, we are asked to collect details of any disability or learning difficulty. For wheelchair users and those with mobility difficulties the information will be used to inform health and safety in the event of an evacuation. Please complete the table below:

☐ / No disability / ☐ / Mental Health difficulty
☐ / Wheelchair user / ☐ / Temporary disability after illness (for example post-viral) or accident
☐ / Visual Impairment / ☐ / Profound Complex Disabilities
☐ / Hearing Impairment / ☐ / Aspergers’ Syndrome
☐ / Mobility affected by disability / ☐ / Multiple disabilities
☐ / Other Physical Disability / ☐ / Emotional/Behavioural difficulties
☐ / Do not wish to provide this information / ☐ / Other:
By completing these details, you are consenting to this information being passed on to an education and careers advisor or your tutor to help us to improve your learning experience.

How would you describe your background?

☐ / Asian or Asian British-Pakistani / ☐ / Mixed- White and Black African
☐ / Asian or Asian British-Any other Asian background / ☐ / Mixed- White and Black Caribbean
☐ / Black or Black British-African / ☐ / Mixed- Any other
☐ / Black or Black British- Caribbean / ☐ / White British
☐ / Black or Black British-Any other Black background / ☐ / White Irish
☐ / Chinese / ☐ / White Any Other White background
☐ / Mixed- White and Asian / ☐ / Any other background

Eligibility Checklist for apprenticeship programmes

To comply with the Skills Funding Agency/EFA Requirements for Funding Work Based Learning for Young People, there needs to be a record to cover the elements identified below.

PART A: ELIGIBILITY

(All applicants must answer these questions)

A1) / Were you born in or do you have full citizenship of either the United Kingdom or any other member state of the European Union/Economic Area? / Yes ☐ / No ☐
Name of Country of Birth
EU states = Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, The Netherlands, United Kingdom.
European Economic Areas = Iceland, Liechtenstein, Norway, Switzerland
A2) / If you were not born in the UK or the EU do you have proof of permanent UK residency / indefinite leave to remain issued by the Home Office? / Yes ☐ / No ☐
Not Applicable (Born in UK) / £
A3) / Have you been living in the United Kingdom or any other member state of the European Union for the last three years? / Yes ☐ / No ☐
A4) / I am not currently on the Work Programme or any other government funded training (e.g. another college course) / ☐
PART B: PROGRAMME SUITABILITY
B1) / Are you currently in full time Education? / Yes ☐ / No ☐
B2) / Have you accepted a place and intend to return to full-time education
in September? (i.e. College or University) / Yes ☐ / No ☐
B3) / Are you a graduate of higher education? / Yes ☐ / No ☐
B4) / Do you currently have any qualifications at level 4? / Yes ☐ / No ☐
B5) / Are you currently in any other funded training programme / Yes ☐ / No ☐
If yes please state which:
PART C: ADDITIONAL INFORMATION

(You only need to complete this section if you were born outside of the EU)

C1) / Has the UK Government granted you refugee status? / Yes ☐ / No ☐
If you have answered YES to question C1, we will need to see your Home Office letter or identity card confirming your residency status. If you have answered NO, then please answer the next question.
C2) / If you have not been granted refugee status, have you been granted Exceptional Leave to Enter or Remain by the UK Government and have you remained in the UK since you were granted this leave? / Yes ☐ / No ☐
If you have answered YES to question C2, we will need to see your home office letter or identity card confirming your status or ID card that states leave is granted. If you have answered NO, then please answer the next question.
C3) / Are you on a learning exchange scheme? / Yes ☐ / No ☐
If you have answered YES to question C3, you will need to provide suitable evidence (i.e. a letter from the exchange programme organiser). If you have answered NO, then please answer the next question.
C4) / Are you an asylum seeker or the child of an asylum seeker in receipt of one of the following benefits? / Yes ☐ / No ☐
Please tick to indicate which benefits:
a) Income based benefits / ☐
b) Assistance under the terms of the Immigration and Asylum Act 1999 or the Children Act 1989 / ☐
c) Voucher assistance from the National Asylum Support Service / ☐
d) Assistance under the National Assistance Act 1948 / ☐
If you have answered YES to question C4, you will need a copy of a letter from the local Asylum Support team confirming your status.

Miscellaneous information

Are you related to or the partner of any Councillor or employee of the Council?

Yes: ☐ No: ☐

If yes, please give brief details:

Such a disclosure will not disqualify you from consideration. However, a failure to disclose any such relationship or the canvassing of Councillors or employees of the Council in relation to this appointment may disqualify you, or may be dealt with under the appropriate procedure, which may include the Disciplinary Procedure.

Have you worked for Southend-on-Sea Borough Council before?

Yes: ☐ No: ☐

If yes, please give details:

Southend Adult Community college welcomes applications regardless of gender, disability, age, ethnicity, sexual orientation or faith.

How did you become aware of this vacancy?

If via a publication, please specify:

The college is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all staff and volunteers to share this commitment and that students and staff can study and work in an environment free from harassment and bullying

The information stated in this application, together with any accompanying papers is, to the best of my knowledge, correct. I understand that a false entry may lead to either an offer of employment being withdrawn or disciplinary action being taken which could result in dismissal.

Name: / Date

Please put an X next to sector you wish to become an apprentice in:

Childcare / Customer Service
Business Administration / Health & Social Care
Teaching Assistant / Facilities Services
Management / Hospitality
Catering / AAT

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