RSPCA Bath & District Branch
APPLICATION FORMFOR
VOCATIONAL EXPERIENCE
Please read and complete sections A, B & C of this form and return to Administrator
at Bath Cats & Dogs Home, The Avenue, Claverton Down, Bath BA2 7AZ
SECTION A: Please tell us about yourself
1.Personal Details
Name______
Address______
______Post Code______
Email address______
Tel No. (Daytime)______Tel No (Evening)______
Date of Birth ______(we regret students under 16 years of age are not accepted)
Mobile telephone number______
2.Health
Do you have any special needs, medical conditions or allergies that may affect your ability to be a vocational experience student at this Centre YES / NO
If yes, please provide details and we will endeavour to make reasonable adjustments to enable you to take up your placement, subject to it not posing a risk to your health
______
______
______
Are you fully protected against tetanus? (we can only accept students who are fully immunised) YES / NO
3.Emergency Contact Details
Next of Kin:______Daytime emergency contact______
(if different)
Name______Name______
Address______Address______
Telephone no______Telephone no______
Mobile no______Mobile no______
Relationship______Relationship______
SECTION B: Please tell us your preferred dates, your interests and experience
- Availability(Please ensure exact dates are given)
College Placement
1 day per week placement on a …Mon/Tue/Wed/Thu/Fri/Sat/Sun
.Start date …………………..Final date.………………………………………
College Block Placement
Minimum of two consecutive weeks may include weekends
Start date …………………..Final date.………………………………………
- Experience
Please give details of your skills, qualifications and career aspirations that
might be relevant to your vocational placement with us
______
______
______
______
______
______
______
______
______
______
SECTIONC: Please tell us about your course(s) and college
Give details about your course(s) ______
______
______
______
______
______
______
______
______
______
______
______
Name of tutor______
Address of college or university______
______
Telephone number of college or university______
DECLARATION
I confirm that my college/ university fully supports my application for a vocational
experience placement with Bath Cats & Dogs Home (“BCDH”)
I understand that as a vocational experience student I am directly accountable
to the staff and management of BCDH
I understand that if my behaviour or actions create an unacceptable risk or
nuisance at BCDH I may be asked to leave immediately
I declare that to the best of my knowledge all the information provided on this application form is correct
I also accept that any personal belongings that I bring to the Home are done so at my own liability as Bath Cats and Dogs Home cannot accept any responsibility for any personal possessions.
Applicant’s signature______Date______
(Please note that in compliance with the Data Protection Act 1988 the information given here will be stored securely and will be accessible only to management and used solely for the purpose of BCDH and will be destroyed immediately after use)
PARENT/GUARDIAN CONSENT FORM
(To be completed on behalf of students that are under 18 years old)
All students on vocational experience at BCDH receive an induction on health and safety, the use of chemicals, code of conduct and animal handling. A copy of this will be given to the student on his/her first day
All measures are undertaken to ensure your son/daughter/ward is safe while working here, but we do ask him/her to act in a mature, sensible manner to ensure a safe working environment, and to abide by the instructions of the staff and management. If these rules are followed, the risk of injury is extremely low as in any other place of work
Please sign below if you consent to your son/daughter/ward to work here on a vocational experience placement
Name of student…………………………………College……………………...
Name of Parent/Guardian………………………………………………………………...
Signed……………………………………………..Dated………………………………….
Signed……………………………………………..Dated………………………………….
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