Hobbies/interests/likes/dislikes e.g. music, food, sport Any other relevant information e.g. planned holidays Education Please continue on a separate sheet if necessary. Date From Date To Name of School/College/ Provider Subjects/Exams Taken include Level e.g. GCSE/Diploma/Functional Skills Grades Actual Predicted (if actual not received) If predicted, due date of actual grades to be received Maths English ICT Any Level 3 Qualification? What school/college did you attend at age 16 years School Name: Town/City Can you provide certificates for your qualifications? Yes No Is there any reason it may be difficult for you to attend regularly and achieve any part of the course? Yes No If yes, how can this be overcome? Work Experience – Employment/Training/Voluntary Please continue on a separate sheet if necessary Date From Date To Name of Company/Branch Position Held Brief Description of Duties Reason for Leaving You may put “See CV” here if you will bring one to interview Disclosure of Information Have you ever been convicted of a criminal offence or currently have charges outstanding? Yes No If yes, please give details. Which one of the following methods of contact do you prefer? Please tick as many as you wish. Text Email Letter Details of Parent/Guardian/Next of Kin (or emergency contact if you live in Supported Accommodation) Title Mr Mrs Ms Miss First Name Mobile No. Surname Telephone No. Relationship to you E-mail
Full Address including Postcode You may put 'see page 1' if they live at the same address as you. Ethnicity How We Use Your Personal Information Please select is applicable to you: 31 – White, British 32 – White, Irish 33 – Gypsy or Irish Traveller 34 – White Other 35 – White and Caribbean 36 – White and African 37 – White and Asian 38 – Other Mixed 39 – Indian 40 – Pakistani 41 – Bangladeshi 42 – Chinese 43 – Other Asian 44 – Black African 45 – Black Caribbean 46 – Black Other 47 – Arab 98 – Other 99 – Not known ZZ – Prefer not to say The personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”) and, when needed, the Education Funding Agency (“the EFA”) to meet legal duties under the Apprenticeships, Skills, Children and Learning Act 2009, and for the Agency’s Learning Records Service (LRS) to create and maintain a unique learner number (ULN). Please read and initial The information you provide may be shared with other partner organisations for purposes relating to education or training. Please read and initial Further information about use of and access to your personal data, and details of partner organisations are available at: , , Equal Opportunities Policy We have an Equal Opportunities Policy that states we provide opportunities to develop the employment potential of all people, in respective of race, religion, gender, disability or unrelated criminal convictions. Declaration I confirm that the information provided on this form is, to the best of my knowledge, accurate and complete. I confirm that I have read the ‘How We Use Your Personal Information’ section and I authorise my details to be checked/used for my application and also if I am accepted onto an Apprenticeship. Signature: Date: