Applicant Name: / Appendix 2
Qualification Panel Application Form
Notes for Applicants:
Prior to completion of this form, please read the Qualification Panel Policy (available on intranet page 4070.
This Application Form is made up of the following sections:
Section 1 – About the applicant
Section 2 – About the proposed Course/Qualification
Section 3 – To be completed by Social Work Degree Applicants only
Section 4 – Applicant Declaration
Section 5 – Statements of support by Line Manager ANDSenior/Area/Professional Lead (Business Support) Declaration.
Please ensure you:
  1. Write your name on the top of each page and complete sections 1 - 4.
  2. Arrange for your Line ManagerANDSenior/Area/Professional Lead (Business Support) to support your application (section 5).
  3. Check that ALL signatures are on the form prior to sending to the Training Unit (typed names will not be accepted.)
  4. Scan copies of your certificates, a copy of your most recent EDR/IPR and the completed application form and send electronically to . If you do not have email access, please send all information to Powys County Council, Business Support Training Unit, 3rd Floor, The Gwalia, Ithon Road, Llandrindod Wells, Powys. LD16AA.
  5. Retain the original copy of your application.
Please note: your application must be received 10 days in advance of the date of the Qualification Panel meeting for it to be considered. Incomplete applications will not be accepted. Dates available on Intranet page 4070.
Business Support Applications - applications will only be accepted where it is evidenced that the applicant provides direct support to the Social Care Workforce.
Section 1 – Personal and Employment Details
Have you applied for and received funding from the Qualification Panel in the past? / Yes
No
Qualification / Achieved: Yes/No / Reason for Non-Achievement
Name
Payroll Number
Current Job Title
Team
Contact Details / Telephone Number / Ext:
Mobile Number
Email Address
Workplace Address
Current Role / Start Date:
Permanent
Temporary – Expected End Date:
Secondment – Expected End Date:
Current Achievements
(Vocational, professional and academic achievements which are related to your work. Please also detail any project work or service development in which you have taken a key role.)
Desired Career Pathway
(How do you see your career developing over the next 2-5 years? How will gaining the qualification/award for which you have applied support this?)
Section 2 – Details of Qualification/Award
Full Name of Qualification/Award
Level of Award
Name of University/ Awarding Body /Training Provider
Date(s) of Commencement
Venue/Location
Number of college days (total)
Number of private study leave days including examination days (total)
NB this is in addition to number of college days
Tier Category
Please identify the category for your qualification/award.
(Further information can be found in the Qualification Panel Policy on Intranet page 4070)
Tier 1
Core
Tier 2
Enhanced (i.e. improves performance and skill mix)
Tier 3
Specialist
Costs
Please provide as much detail as possible to support your application.
NB: You do not need to complete this section if you are applying for the Open University Degree in Social Work.
Tuition Fees/ Programme Fees
Estimate of Travel Costs
Any other costs, eg. accommodation, books (please specify)
Are you in receipt of any other funding in relation to this qualification?
Yes
No
If yes, please provide further information:
Section 3 – Degree in Social Work Applicants Only
Applicants who apply for this training MUST have achieved all of the following:
  • Maths GCSE Grade C or above or equivalent
  • QCF Health and Social Care Level 3
  • K101
(For further information please see Intranet page 2347)
If accepted on the Powys County Council in-house secondment scheme it would be on condition that you agree that once you have qualified, you will work in the geographical area and service sector in which there is a need for social workers at that time (either in North or South Powys, including Llandrindod Wells in each case depending on where you live).
NB Signing of this application will be taken as confirmation that you agree to this condition
  1. Please state briefly how your experience in the workplace has prepared you to study for the Degree in Social Work.

  1. To what extent do you think you understand what is involved in study for the Degree in Social Work with the Open University?

Section 4 - Applicant Declaration
I declare that all the information given by me on this Application Form is true and correct to the best of my knowledge.
I agree to commit the required time and effort to complete the training applied for.
If there are any changes in my employment position/circumstances, I will inform the Training Unit immediately in writing.
On completion of the above course, I will provide copy of my certificate to The Training Unit to enable updating of Training Records, including Trent.
For Social Work Degree Applicants Only
I agree that, if I am accepted on the Powys County Council in-house secondment scheme it would be on condition that I agree that once I have qualified, I will work in the geographical area and service sector in which there is a need for social workers at that time (either in North or South Powys, including Llandrindod Wells in each case depending on where I live).
Signing of this application will be taken as confirmation that I agree to this condition.
Applicant Signature
Date
Section 5 – Support for Application submitted to Qualification Panel
To be completed by Line Manager prior to comments from Senior/Area Manager/Professional Lead Business Support.
  1. What staff replacement arrangements including number of staff replacement days have been considered? What is the cost implication for the service?

  1. Will this application have an impact on service delivery? Please comment on any considerations or measures which will be put in place to support the continued delivery of high quality services.

I have discussed this application with the applicant and based on current knowledge confirm (by ticking each box):
The applicant is suitable to successfully complete the programme within the required timescales.
As the applicant’s Line Manager I can offer the applicant opportunities sufficient to evidence the programme requirements and learning outcomes.
There is no reason to believe why the applicant will not be able to apply the learning gained in day to day practice.
I understand the implications for my Team in terms of the absences that the applicant will require as part of this whole programme, including course attendance and supported study time. I am able to release the applicant for those periods.
Name of Line Manager
Job Title:
Signature:
Date:
To be completed by Senior/Area Manager/Professional Lead Business Support
Application Supported (please tick) / Yes
No
Reason(s) for decision to support/not to support application
Name of Senior/Area Manager/Professional Lead Business Support
Job Title:
Signature:
Date:
Applicant Checklist
Application Form fully completed and declaration signed
Line Manager completed and signed
Senior/Area Manager/Professional Lead Business Support completed and signed
EDR/IPR attached
Certificates attached
OFFICE USE:
Date Received:
Application Form Complete
EDR/IRP Received
Certificates Received
Qualification Panel Date:

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