Application Form

Position applied for
Employer Name

Personal Information

First Name (s) / Last Name
Address
Postcode
Telephone No / Mobile No
Email Address
National Insurance Number
Date of Birth
Gender (please tick) / Male / Female

Specific Learning Disability or Difficulty (SpLD)

Do you consider yourself to have a particular disabilityunder the terms of the disability act? Yes / No
Do you have any health problems that could affect your ability to work or train? Yes / No
Are you currently under medical supervision or taking any course of regular medication? Yes / No
If you answered Yes to any of the above please provide further details:
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Note: In order to ensure that you are fully supported a risk assessment may be completed prior to you
commencing on your programme to ensure that you are provided with adequate support throughout
your programme.

Employment/Work Experience Information

Please give details of roles you have held starting with your current/most recent post.

Current or most recent employment or work experience

Job Title / Dates Employed / To: / From:
Name and address of company:
Salary (state if this was work experience) / Other benefits
Notice Period / Reason for leaving
Brief description of duties:

Previous Employment/Work Experience

Job Title / Date To & From / Employer Name & Address / Main Duties / Reason for Leaving

Previous Employment/Work Experience

Job Title / Date To & From / Employer Name & Address / Main Duties / Reason for Leaving

If you wish to include more employment history, please include on a separate sheet.

Education and Qualifications

Dates from and to / Name of school, college or university / Subject / Level / Grade

Please provide details of why you have applied for this role

Include any previous experience and the reasons why you are interested in working in this particular industry. Please explain why you think you would be good at this job and what personal qualities you can attribute to the role. (No more than 500 words)

Emergency Contact Details

Please provide details for your next of kin, who we would contact in the case of an emergency.

Name:
Address:
Telephone No
Email Address:

Positive about Disability

We are a Positive about Disability Employer, and disabled applicants who meet the specified job criteria are guaranteed an interview. Please tick if you feel this is relevant to your application.

We want all applicants to be able to give their best during the interview stage. Please details below any reasonable adjustments required, should you be selected for interview.

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______

______

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Other information

Where did you hear about this vacancy?
Method of transport to and from your proposed place of work or learning / Car/Motorcycle Driver: YES / NO
Public Transport: YES / NO
If unsuccessful are you be happy for us to contact you about other training opportunities available at Juniper Training? / YES / NO

Applicant Eligibility Checklist

Applicant Name: ______

Juniper Staff Name: ______Date of Interview: ______

A – CONTRACTUAL

Is the student / Type of Evidence / Yes / No
Has the student “settled” and been ordinarily resident in the UK and Islands (that is including the Channel Islands and Isle of Man) for at least three years preceding their start date? Note: Settled means having indefinite leave to enter or remain or having the right to abode in the UK. Please use the RO guidance for clarification.
Is the student a Year 11 School Leaver or aged 16, 17, 18 on the day they start the programme or age 16-24 with SpLD? NOTE: Please write not applicable for adult applicants.
If the student has answered NO to any of the above, they cannot join a programme at Juniper. Do not complete sections B, C and D.

B - GENERAL

Is the student / Yes / No
Undertaking any other full-time education, training or work based programme?
Demonstrating English and Maths at Pre-Entry or Entry Level 1?
If the student has answered YES to any of the above, they cannot join a programme at Juniper. Do not complete sections C and D.

C – INITIAL ASSESSMENT

Has the student / Yes / No
Demonstrated a minimum of 45% at Entry 3 in English Diagnostic Test?
If the student has answered NO to any of the above, they cannot join the MINT Programme. Do not complete section D.

D - OTHER:

Is the student / Yes / No
Able to attend the programme for at least 20 hours per week?
(unless on JSA)
Educated to GCSE with D to G grades or Educated to fewer than 5 GCSEs grades A-C
If the student has answered NO to any of the above, they cannot join a programme with Juniper. If yes then we will now move to decide Which Programme is Right for You?” to consider if you should be on a MINT or Traineeships programme. This will be decided once your initial assessment/engagement period has been completed.

I confirm that the information recorded on this form to assess my eligibility to join a programme with Juniper is true and accurate.

Signed (Student): ______Date: ______

I confirm that this student is eligible to join a programme with Juniper. Please move on to the next part of the form to identify which programme will be most beneficial for the learner.

Signed: ______Date: ______

Notes/Reason for non acceptance______

Learning Records Service (LRS) Agreement

Student Name: ______

  • Theinformation you supply will be used by the Skills Funding Agency to issue and/or verify your Unique Learner Number (ULN). This number will be used to create and/or update yourown Personal Learning Record (PLR).
  • Your Personal Learning Record willinclude information about your qualifications, awards, training and learning achievements that you may collect throughout your lifetime – at all levels and also whilst you are working and learning.
  • It also means that your Personal Learning Record can be shared with other organisations that have a responsibility for providing funding and serving your education and training.
  • For further details about how the information you have provided to us will be used, please ask a member of Juniper staff or refer to the Learning Records Service website:
  • If you are below the age of 16, you might wish to discuss this privacy notice explanation with your parent or legal guardian.
  • The Skills Funding Agency is a public body which funds some of the qualifications and training that you may be receiving through your college, training or learning provider. It is responsible for maintaining ULNs and PLRs on behalf of all individuals aged 13 and above in England, Wales and Northern Ireland.
  • Your Unique Learner Number (ULN) is a ten digit reference number and is unique and individual to you. Please keep this number in a safe place since you will need it during your lifetime, just like your National Insurance number.
  • It will also be used to create and/or update your own Personal Learning Record (PLR). This record will include information about your qualifications, awards, learning achievements and ‘credits’ which will be conveniently located in one online area for you and your advisors to refer to, with your permission. Your record will help you to confirm to others, what you have learned, where and when. It will also help you identify other areas of learning to help you progress towards your own goals. Please note that you will always be in control of who accesses your Personal Learning Record. Only you can give them permission to view the information.
  • Your Personal Learning Record will be conveniently located online for you to access at
  • The Skills Funding Agency may obtain and use third party reference data to assist when verifying your Unique Learner Number (ULN) and when checking that the data it holds about you is correct, in order to comply with the requirements of the Data Protection Act to keep your details accurate and up to date.
  • The Skills Funding Agency may use your information for management and statistical purposes and for monitoring the accuracy of the information it holds about you.
  • Your Unique Learner Number (ULN) and Personal Learning Record information may be shared with other education related organisations, such as your careers service, school, college, university, Government Departments and public bodies responsible for funding your education. Such information includes qualifications, awards, certificates, work-based training and learning (this is also called achievement and participation data). Your Personal Learning Record will be a lifelong record of your participation, learning and achievement in education. Your Personal Learning Record will be accessible to you, plus to organisations linked to your education and any other organisations you allow to view your Personal Learning Record for the purposes of advice and guidance.
  • Please note that you can opt-out of the Skills Funding Agency sharing your Personal Learning Record. However, you can not opt-out of the Skills Funding Agency storing your information.
  • You can opt-out of sharing your participation and achievement data by contacting the LRS Customer Helpdesk on 0845 602 2589. You will be required to provide some personal details to confirm your identify, which may include your Unique Learner Number (ULN), if known.
  • For full details of how your information is shared and used by the Learning Records Service and how to opt-out or modify who has access to your information please visit the Learning Records Service website at:

I consent to Juniper accessing to my Personal Learning Record

Student Signature: ______Date: ______

Equality & Diversity Monitoring

To ensure we are meeting our commitment to equality, we need to know about the age, gender and ethnic origin of people who apply to us, and whether they regard themselves as disabled. By completing this section and you will help us effectively monitor recruitment. NOTE: This in no way forms part of our selection process.

Gender / Male / Female (Delete as appropriate)
Age / 16-18 / 19-24 / 25-55 / 56+

Ethnicity

White
White British
White Irish
Any other white Background
Black or Black British
African
Caribbean
Other Black Background
Chinese
Chinese
Other ethnic group / Asian or Asian British
Bangladeshi
Indian
Pakistani
Other Asian Background
Mixed
White and Asian
White and Black Caribbean
Any other mixed background
If other, please specify ______

Please provide information on the following, if you prefer not to disclose, please leave blank

Religion
Sexual Orientation

Disability

Do you consider yourself to have a disability under the term of the disability act? Yes / No
If Yes, please state nature of disability:

Photography Consent Form

As part of you programme, Juniper Training may take your photograph or film activities that you are taking part in. These could be used as evidence to support your qualification or for documentary/promotional purposes.

Juniper will take all reasonable measures to ensure that these images are used only for the purposes for which they are intended. If you become aware that these images are being used inappropriately you should inform Juniper immediately.

Images may be used on Juniper Trainings website or through other social media feeds. Images may also be printed and displayed in our centres or shared with partner organisations like the ESFA.

Please circle YES or NO to the questions below:

  1. May we use your image in our own printed material produced for
Promotional and documentary purposes?
  1. May we use your image or success stories for our website?

  1. May we use your image or success stories on our social media sites?

  1. May we record your image on our promotional videos?

  1. May we use your image in printed publications produced by others for
Promotional and documentary purposes?
  1. Are you happy to have your photograph taken or activities to be recorded
For evidence to support your qualification or learning programme?

NOTE: Your image will only be used in the capacity in which you choose by indicating above.

The information you have given above will be treated in strict confidence.
Important: Data Protection Act (1998). This form asks you to supply “personal” data as defined by the Data Protection Act 1998. You will be supplying this data to the appropriate HR or security authority where it may be processed exclusively for the purpose of a check against the National Collection of Criminal Records. The HR or security authority will protect the information which you provide and will ensure that it is not passed to anyone who is not authorised to see it.
By signing the declaration on this form, you are explicitly consenting for the data you provide to be processed in the manner described above. If you have any concerns, about any of the questions or what we will do with the information you provide, please contact the person who issued this form for further information.

Juniper Staff Use Only

Please state the type of evidence used to establish the
students identify (E.G. Passport, NI Card, etc) and record the
number or reference
Staff members name and signature to confirm the original has
been seen

Declaration

I declare that the information I have given as part of my application is true and complete, to the best of my knowledge and belief. I understand that giving false information or deliberate omission may result in my traineeship/apprenticeship being withdrawn or rejected and if discovered after appointment, may be grounds for dismissal. I understand that it is my responsibility to inform Juniper Training of any changes to my personal circumstances that may impact my application.

Signature Date

If completing this form electronically, please type your name in and you will then be asked to sign the application form if selected for interview.

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