Student placement Application Form

Bird Department and Chough Project

Please carefully complete each section of the form in black ink or typewritten and email to or post to the Dr Eluned Price, Durrell Wildlife Conservation Trust, Les Augrés Manor, La Profonde Rue, Trinity, Jersey, JE3 5BP.

PERSONAL DETAILS
Surname: First Names: Title:
Other surnames you have been known by:
Address:
Post code:
Home : Work :
Mobile : Email address:
Do you hold a full current driving licence? Yes [ ] No [ ]
APPLICATION

This placement is for 12 months from September 2016 to September 2017. Please give your available dates during this time:

Are you currently in higher education?

Yes No

If yes please give details(course,year,qualification etc.):

Are you required to complete a work placement as part of your higher education?

Yes No

If yes please state the length of placement required by your institution:

EDUCATION AND QUALIFICATIONS

Secondary/Further Education

Starting with the most recent:

School / College or University / Subject or Course / Examination e.g. GCSE / Grade

Further Academic Qualifications

From / To / Qualification / Award / Obtained at

Relevant Training Courses Attended

From / To / Training Provider / Course Title

EMPLOYMENT / VOLUNTEERING HISTORY

In each case please specify whether you were volunteering or a paid employee.

Employer / Employed from
__ / __ / __ / Employed to
__ / __ / __ / Position held, duties and reasons for leaving
Full Name and Address
:
Full Name and Address
:
Full Name and Address
:

Please continue on a separate sheet using the same format if necessary.

SUPPORTING STATEMENT

Please state why you are interested in a student placement at Durrell

Do you have any particular skills or experience that you feel would be relevant to a placement at Durrell?

What are your expectations of a placement at Durrell?

Supporting statement

In this section you please give details of how you feel the placement would benefit you and what you could give back to Durrell. Please continue on a separate sheet if necessary.

REFERENCES

Please give the details of two referees who can verify your information and confirm your suitability for a placement.

Name:
Job Title:
Address:
Tel:
Fax Number:
Email Address: / Name:
Job Title:
Address:
Tel:
Fax Number:
Email Address:

Are you happy for us to contact your referees prior to induction? YES / NO

DISCLOSURE OF CRIMINAL RECORD

All candidates for posts which give them access to children or young people are required under the Rehabilitation of Offenders (Jersey) Law 2001, if offered a placement, to disclose details of all previous convictions. Disclosure of any criminal conviction(s) will not necessarily debar you from a placement with DWCT - this would depend on the nature of the offence(s) and their relevance.

Failure to declare previous convictions may terminate your placement if it subsequently becomes apparent that you do, in fact, have a criminal record. Some placements offered by DWCT will be subject to completion of a DBS and a receipt by of a satisfactory Disclosure certificate.

Please answer the following questions:

“Do you have any unspent convictions, cautions, reprimands or warnings?”

Yes No

ASSOSCIATION WITH DURRELL WILDLIFE CONSERVATION TRUST

Have you ever competed at placement atDWCT before?

If yes, please give details (dates, department etc.):

______

Have you ever attended any of our courseat the Durrell Training Academy?

If Yes please give details (date, course title etc):

______

HOW DID YOU HEAR ABOUT US?

To help us monitor our advertising, please state where you first saw the placement advertised:

______

PLEASE READ THE FOLLOWING DECLARATION CAREFULLY BEFORE SIGNING THIS FORM

I declare that the information given in this form is to the best of my knowledge complete and correct. I understand that DWCT reserves the right to seek verification of any information provided. I understand that if it is discovered that I have given false information I may be asked to leave the placement programme.

DWCT complies with the Data Protection (Jersey) Law 2005.

Signature...... Date...... …......

Name (Print)...... …………….………………………………......

‘Until we consider animal life to be worthy of the consideration and reverence we bestow upon old books and pictures and historic monuments, there will always be the animal refugee living a precarious life on the edge of extermination, dependant for existence on the charity of a few human beings.’ Gerald Durrell