Unpaid Work Experience Application Form

PLEASE COMPLETE ALL SECTIONS IN BLOCK CAPITALS USING A PC OR A BLACK PEN.

PERSONAL INFORMATION
ARRIVAL DATE IN UK / DEPARTURE DATE
Family Name / First Name
Date of Birth / Nationality
Sex / () Male Female / Occupation
Address
City / Postcode
Country / Passport / ID Number
Mobile / Telephone
E-mail
Do you have a DBS/CRB police check?(if yes please provide a certified copy) ( ) Yes No
This is mandatory for placements in schools and other sectors when requested
Do you have any unspent criminal convictions? () Yes No
If yes, please provide full details on a separate sheet
WHO SHOULD WE CONTACT IF THERE IS AN EMERGENCY?
Name / Relationship
Address
Country / Telephone
Mobile / Email
INSURANCE
All participants must have appropriate travel and medical insurance coverage prior to arriving in the UK for the full duration of their stay.
Do you understand and agree to this? ( ) Yes No
YOUR TRAVEL ARRANGEMENTS
Planned UK arrival airport
Planned UK departure airport
Do you require a private transfer from the arrival airport to your destination? () / Yes No
Do you require a return private transfer to the departure airport? () / Yes No
Would you like us to organise a local travel pass for your stay in the UK? () / Yes No

Flight details and travel arrangements should be provided to TTPL at least 10 days ahead of travel to/from UK

YOUR HEALTH AND CULTURAL NEEDS
Do you have any special dietary needs () /principles?(e.g. gluten free, vegetarian, no pork) / Yes NoIf yes, please tell us about them:
What is your religion?
Or () / none / prefer not to say
Do you have any special religious, cultural or () other needs? / Yes NoIf yes, please tell us about them and complete medical form if necessary:
Do you Smoke? () / Yes No
Do you have any allergies? () / Yes NoIf yes, state and complete medical form
Do you have any current or historical medical ()
conditions?* / Yes NoIf yes, please complete medical form
Are you taking any regular medication? () / Yes NoIf yes, please complete medical form
Are you receiving any medical treatment? () / Yes NoIf yes, please complete medical form
Do you have any current or historical mental ()
health problems?* / Yes NoIf yes, please complete medical form
Do you have a disability which is relevant to your application? / Yes NoIf yes, please complete medical form
Medical form enclosed? () / Yes No

* Historical medical condition is any physical or mental condition occurring within the past 5 years, or where there is the possibility of re-occurrence then there is no time limit.

YOUR ACCOMMODATION
Which type of accommodation do you require: ()
Half Board (breakfast, evening meal & assistance with laundry)
Full Board (breakfast, packed lunch, evening meal & assistance with laundry)
Self-Catering (no meals or laundry included)
Single room required (supplement payable, subject to availability)
Accommodation special requests e.g. share with friend(s) & name(s):
LANGUAGE SKILLS
Mother tongue?

SELF ASSESMENT OF ENGLISH LANGUAGE LEVEL (Summary of completed ELP Form)

Understanding / Speaking / Writing
Listening / Reading / Spoken interaction / Spoken production
Number of years English study / years

Other Languages

/ #1: / Nil Fair Good Fluent
#2: / Nil Fair Good Fluent
#3: / Nil Fair Good Fluent
YOUR TRAINING REQUIREMENTS
General English Yes No / How many weeks would you like to study?()
1 2 3 Other weeks
Conversational English Yes No
(groups only) / How many sessions would you like to study?()
1 2 3 Other sessions
Cultural Awareness Yes No
(groups only) / How many sessions would you like to study?()
1 2 3 Other sessions
Employability Yes No
(groups only) / How many sessions would you like to study?()
1 2 3 Other sessions
Communicating with confidence Yes No
(groups only) / How many sessions would you like to study?()
1 2 3 Other sessions
YOUR WORK PLACEMENT REQUIREMENTS
Please state the business areas you would like to work? (e.g. administration, hospitality, retail, engineering)
Choice #1:

Choice #2:

Please describe the type of tasks and work you would like to undertake?
Other than improving your English, what are your expectationsconcerning the experience, what skills and knowledge would you want to use whilst in your placement and what are your motivations for undertaking this experience?
Please list your work / computer / other skills: (eg CAD, milling and drilling, social media)

YOUR HOBBIES AND INTERESTS

Please tell us about your hobbies, interests and what you do in your spare time:
YOUR FUTURE
What do you want to do at the end of your studies?
What is your career goal or ambition?

OTHER INFORMATION

Use this space to tell us anything else relevant to your application and stay in the UK:

DECLARATION

I certify that the information I have given in connection with this application is true and correct.
I give my permission to The Training Partnership Ltd to use this information and other documents I have enclosed to fulfil my requirements and agree to this information being passed to other people and organisations as necessary.All information provided will be held by TTPL in accordance with the Data Protection Act 1998
I agree to the terms and conditions of The Training Partnership Ltd.
Signed:______Name: Date:

CHECKLIST: ()

Application signed?
Copy I.D. / Passport enclosed?
C.V. enclosed?
Letter of motivation enclosed?
ELP completed?
Health form enclosed if required?
Parental Consent (if under18 at time of arrival) enclosed?
Certified CRB/DBS (Police) Check if required?