Get documents about "Work Based Apprenticeship Application FormAugust2011
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APPLICATION FORM
PLUMPTON COLLEGE APPRENTICESHIP/WORK BASED LEARNING
This form should be completed in BLOCK CAPITALS and returned to: Plumpton College, Ditchling Road, Plumpton, East Sussex BN7 3AE
Programme for which application is made: Year of Entry
Surname Title* Mr / Mrs / Miss / Ms /Other
* Delete as appropriate
Forename(s) in full
Date of birth
National Insurance No. Nationality:
Home Address Address for correspondence if different:
Post Code:
Tel No: (inc area code)
Mobile telephone No:
Email Address:
EU resident for 3 years ❏ Yes ❏ No Please tick as appropriate
ETHNICITY
Asian or Asian British - Bangladeshi ❏ Mixed - White and Asian ❏
Asian or Asian British - Indian ❏ Mixed - White and Black African ❏
Asian or Asian British - Pakistani ❏ Mixed - White and Black Caribbean ❏
Asian or Asian British - any other Asian background ❏ Mixed - any other Mixed background ❏
Black or Black British - African ❏ White - British ❏
Black or Black British - Caribbean ❏ White - Irish ❏
Black or Black British - any other Black background ❏ White - any other White background ❏
Chinese ❏ Any other ❏
No known/not provided ❏
QUALIFICATIONS
Please list all the qualifications you have gained or to be taken (must be completed).
Qualifications Subject Grades Copy certificate
i.e. GCSEs, NVQs, BTEC, Degree attached
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
NB Please attach copies of all examination result slips or certificates – failure to provide copies will delay the progress of
your application.
LEARNING DIFFICULTIES/DISABILITIES
a) Do you have any learning difficulties/disabilities/medical conditions? ❏ Yes ❏ No
b) Do you have a Statement of Educational Needs? ❏ Yes ❏ No
c) Are you registered disabled? ❏ Yes ❏ No
d) Do you have any medical condition which may affect your study? ❏ Yes ❏ No
If you have answered 'YES' to any of the above questions, can you please provide more details:
This information will be treated in confidence and will not be prejudicial to your application.
If you are aged 16-18 and are/will be employed as an apprentice your course fees will be paid by the
Skills Funding Agency
EMPLOYMENT
PLEASE NOTE: Apprentices must be in paid employment in a related industry. Train to Gain learners must be either in paid
employment or volunteering in the workplace.
Are you employed in a relevant job? ❏ Yes ❏ No Invoice Address
Name of Business Contact Name:
Contact Name
Address
Post Code Tel No:
E-mail
Website
Date Employment commenced
Course Code Title Total Cost Office Use – Invoice No
£
EMPLOYER DECLARATION
‘I confirm that, to the best of my knowledge, the information on this form is correct. If the named learner is employed by me as an apprentice or
otherwise, I declare that they have a contract of employment. NB Apprentices must receive a minimum wage of £95.00 per week.
If the named learner is a volunteer within my organization, they are unpaid
We agree to pay for the course(s) detailed and related costs upon receipt of Plumpton College’s invoice.
Employer Name Employer Signature
Position Date
Wbl application 08/11
PERSONAL STATEMENT - LEARNER
Please use this space for any statement supporting your application, including hobbies and interests. If you are a mature student,
without formal qualifications, you may wish to outline the skills and strengths you have to offer.
Please use a separate sheet if required.
CAREER AMBITIONS
Please state your future career ambitions.
CRIMINAL CONVICTIONS
The College has a duty of care, particularly to learners who are under 18 years of age. In view of this, all applicants are required to
declare any criminal convictions. All information given will be treated as sensitive data under the Data Protection Act and dealt with
in accordance with our Equal Opportunities Policy and Admissions Policy.
Do you have any criminal convictions? (excluding fixed penalty driving offences) ❏ Yes ❏ No
If YES, details should be given in a sealed envelope marked confidential.
DATA PROTECTION
Information you provide on this application form will be passed to the Skills Funding Agency which is registered under the Data Protection Act 1984. The
registration is primarily for the collection and analysis of statistical data, but it also allows the Agency to share information with other organizations for
the purposes of detecting fraud. Further information about data confidentiality is available on request from the college. The information you supply will
be used by the Chief Executive of Skills Funding, to issue you with a Unique Learner Number (ULN), and to create your Personal Learning Record.
Further details of how your information is processed and shared can be found at www.learningrecordsservice.org.uk/privacynotice
DECLARATION
I understand that the above information forms the basis on which a programme with the College may be offered to me, and declare these
particulars are to the best of my knowledge correct. I also understand that a place may be withdrawn if undeclared criminal convictions
subsequently come to light.
I am not currently on any other government funded training.
Signature of Applicant: Date
Signature of Parent/Guardian if applicant is under 18 years of age Date
How did you find out about this College?
Careers teacher ❏ Internet ❏
Newspaper ad ❏ From a friend or relative ❏ From attending a previous course ❏
Careers event ❏ Show/Exhibition ❏ Other - please state below ❏
Tick here if you do not wish to receive details of further services or courses from the College ❏
Wbl application 08/11
For Plumpton College use only
Interviewer please complete in full
Interview conducted by: Date of interview:
Apprentice ❏ Advanced Apprentice ❏ Train to Gain ❏ Other ❏
Career intentions explored: ❏ Yes ❏ No
Course objectives explained and discussed –
to include Functional Skills and Technical Certificates if applicable
to include Functional Skills and Technical Certificates if applicable
Is the programme still appropriate to the applicant? ❏ Yes ❏ No
Eligibility
Confirm applicant has completed end of School Year 11 and DOES NOT intend to return to full time education
during the Training Programme and IS NOT:
Attending another FE/HE College,
In any other employment or learning scheme
A graduate
In custody or on remand in custody
Eligibility Confirmed ❏ Yes ❏ No
Academic/Personal Issues
Additional Learning Support Required ❏ Yes ❏ No
Was applicant assessed/received Learning support at school ❏ Yes ❏ No
Is there a need to investigate further ALS ❏ Yes ❏ No
UNCONDITIONAL OFFER ❏ CONDITIONAL OFFER ❏
Comments:
Signed (Programme Leader) ………………………………………………………………………………………… Date: ……………………….
Office Use Only
Exam Board Title Complex Unit Codes
Codes/
Scheme
ADDITIONAL QUALIFICATIONS as listed in Lantra framework requirements
Plumpton College
Ditchling Road, Plumpton, East Sussex, BN7 3AE
Tel: 01273 892030 Email: wbl@plumpton.ac.uk; www.plumpton.ac.uk
Wbl application 08/11
