APPLICATION FORM

WEARDALE RURAL SKILLS TRAINING

Application form – 2 sheets
PART 1 (PARTS 1–2 TO BE COMPLETED BY EMPLOYER/SELF EMPLOYED PERSON)
NAME & ADDRESS OF
FARM BUSINESS:
CPH NUMBER OF BUSINESS:
NAME OF PERSON RESPONSIBLE FOR AUTHORISING TRAINING ON BEHALF OF BUSINESS:
First Name(s): / Surname:
Address:
Postcode: / Contact Numbers: / (1)
(2)
Email address(es): / (1)
(2)
Signed: / Date:
PLEASE PRINT NAME BELOW AND GIVE DETAILS OF AUTHORISED CAPACITY
Name (printed) / Authorised Capacity
I/WE CONFIRM THE ABOVE APPLICANT IS AN EMPLOYEE/WORKER WITH OUR FARM BUSINESS, SITUATED IN WEARDALE (OR EMPLOYEE RESIDING IN WEARDALE), & SUPPORT THEIR APPLICATION FOR PART FUNDED TRAINING. I/WE UNDERSTAND PART FUNDING IS SUBJECT TO THE SPECIFIED CONTRIBUTION BEING PAID IN ADVANCE OF NOTIFIED TRAINING DATES (NOTIFICATION BY PHONE OR E-MAIL BY UTASS).
PART 2 - NAME OF PERSON APPLYING FOR TRAINING:
First Name (s): / Surname:
How long has this person been employed (or self-employed) by this business?
PLEASE COMPLETE BOTH SIDES OF THIS FORM & RETURN TO :
Julia Stephenson, Training Co-ordinator, UTASS, 9-11 Chapel Row, Middleton-in-Teesdale, Barnard Castle, DL12 0SN. E-mail Phone 01833 641010

APPLICATION FORM

WEARDALE RURAL SKILLS TRAINING

PART 3A (& B BELOW) – TO BE COMPLETED BY APPLICANT

Name(s): / Surname:
Address (home):
Postcode: / Contact Numbers: / (1)
(2)
Email address
Date of Birth / Student ¨ / Other ¨
/ Gender: / Male ¨ / Female ¨
Status: / Employer ¨ / Employee¨ / Self employed¨ / Ethnicity
Trainee Signed: / Date:
Trainee Name : (printed)

PART 3B – TRAINING REQUESTED IN PRIORITY ORDER – PLEASE DETAIL IN BOX WITH 1 = TOP PRIORITY

Artificial Insemination / Contribution for 3½ days £178+VAT / 1 day theory; 2½ days practical
BWMB Shearing / Contribution for 2 days £90+VAT / 2 day course
Chainsaw (Lantra/NPTC) / Contribution for 2 days £100 / 2 day course
Car & Trailer Lessons / Do you have B on your licence?
Do you have any endorsements?
Contribution £120 inc VAT for 4 lessons / YES ¨ / NO ¨
No ¨ If yes, please detail below
Drystone Walling (Lantra)
Level 1 / Several days training may be needed
Contribution - £50 / Length of training dependent on previous level of skill
Emergency First Aid / FREE OF CHARGE / Specific to outdoor workers
1 day course
Safe Use of Pesticides / Contribution - £190 no VAT / 1 day each for Theory & Practical + slot for NPTC assessment
Telescopic Handler (NPTC) / Contribution 2 days £175+VAT / Venue to be arranged locally
Please detail how the training will benefit you

PLEASE COMPLETE BOTH SIDES OF THIS FORM & RETURN TO: Julia Stephenson (details on page 1)

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