The Core at Corby Cube Work Experience Expression of Interest Form

The Core at Corby Cube Work Experience Expression of Interest Form

Title:
First Name:
Surname:
D.O.B
Which Experience are you interested in? If applicable
Home Tel:
Mobile Number:
Email:
School/College:
Subjects Studying:
Hours needed for your work experience / Under 10 / 10 - 20 / 20 - 30 / 30 - 40 / 40 - 50 / 50 +
Why do you want to do work experience at The Core?
(Max 250 words)
What do you want to learn/gain in your time here at The Core?
(Max 250 words)
What are your hobbies/interests?
Availability: / Time Slots: / Mon / Tue / Wed / Thu / Fri / Sat
Morning
Afternoon
Evening

How did you hear about work experience at The Core at Corby Cube?

 The Core Website  Royal & Derngate Website  Corby Borough Council Website Box Office  College/ School  Word of Mouth  The Core Brochure  Other

The Core strives to be an Equal Opportunities Employer. It aims to establish and maintain a working environment, terms and conditions of service and employment practices and procedures which will ensure that no job applicant, employee, placement, actor or member of one of our groups/workshops receives less favourable treatment on the grounds of race, religion, belief, colour, nationality, ethnic or national origins, disability, gender, marital status, sexual orientation or age. We are required by our principal funders to monitor ethnic origin, gender, sexual orientation and disability, and would be grateful if you would complete this form to enable us to do this. The information provided will be treated as strictly confidential. It will be used for monitoring purposes within the organisation and will assist us to make decisions that will ensure that we remain an Equal Opportunities Employer. Please note the categories used are those recommended by the Office of National Statistics and the charity Stonewall.

I would describe my (the young person) ethnic origin as (please tick appropriate box)

English/Welsh/Scottish/Northern Irish/British / Irish / Gypsy or Irish Traveller / Any other white background / White and Black Caribbean / White and black African / White & Asian / Any other mixed/multiple ethnic Background
Indian / Pakistani / Bangladeshi / Chinese / Any other Asian Background / African / Caribbean / Any other Black/African /Caribbean Background
Arab / Any other ethnic group / Not Known/prefer not to say

Gender

Male / Female / Transgender / Prefer not to say

Disability

Do you have a physical, sensory or mental impairment that seriously affects your day-to-day activities? (Please tick as appropriate)

Yes No Information Declined to be given 

(This definition includes people with heart disease, diabetes, epilepsy, severe disfigurement, depression, schizophrenia, Down's syndrome, dyslexia and many other types of impairment).

Please describe any special requirements you need while at The Core as a result of your disability:

………………………………………………………………………………………………..………………………………………………………………………………………………..………………………………………………………………………………………………..…………………………………………………………………………………………………………………………………………………….

I confirm that the information provided on this Work Experience expression of interest form is complete and true.

Signed______Date ______