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WORK PLACEMENT/EXPERIENCE APPLICATION FORM
Please refer to criteria within the Work Placement/Experience Policy before submitting an application form. If criteria is met, please complete this form and return by post to the HR Department. Please use blue or black ink, or complete electronically and e-mail to: workexperience@pinewoodgroup.com Work placement/experience applied for: (state the department or general) Dates of work placement/experience: Please specify if there is a date you will require a response by:
Surname Other Names Preferred Title (eg Mr, Miss, Mrs, Ms) Home Telephone

From

To

Previous Surnames Home Address

Mobile Telephone

Postcode
Email Address Work Telephone (if it is convenient for contacting you) Age at start of placement

Date of birth

Are you applying for a work placement/experience through a Pinewood Group employee? If YES, please tell us the name of the employee and your relationship to them

Yes

No

Do you require a work experience permit? Do you hold a full current driving licence? Do you have the daily use of a car? Have you previously sought a work placement/experience with Pinewood Group? If YES, please give details

Yes Yes Yes Yes

No No No No

What is the name of your current/last education establishment?

Work Placement/Experience Application Form

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EDUCATION
Please start with the most recent qualification achieved
Dates From To Name & Address of Establishment Examinations Passed (please state if grade given is predicted and not yet awarded) Awarding body Qualification Grade

Other Qualifications held including vocational qualifications

Dates Awarded

Are you a member of a professional body ? If yes, please specify

Yes

No

Work Placement/Experience Application Form

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RELEVANT EMPLOYMENT HISTORY
Please list any work experience and employment relevant to your application.
Dates From To Employer’s Name & Address Job Title & Brief summary of duties

OTHER EMPLOYMENT HISTORY
Please list any other work experience and employment that you have undertaken.
Dates From To Employer’s Name & Address Job Title & Brief summary of duties

Work Placement/Experience Application Form

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PERSONAL STATEMENT
Please give your reasons for applying for this work placement/experience. Outline the skills, experience and personal qualities that are relevant to the placement.

Work Placement/Experience Application Form

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SUPPLEMENTARY QUESTIONS
What are your interests?

Do you have a disability ?

Yes

No

If so, please state what type of adjustments to working arrangements would assist you in overcoming any disadvantage that your disability might otherwise cause you at work.

DECLARATION
I declare that the information set out in this application form is true and complete. I understand that if my application is incomplete, I may not be considered for a placement. Any false statement may result in rejection as a candidate and/or cancellation of a placement if an offer is made or a placement has commenced. Please attach a CV.
Date

Signed

Work Placement/Experience Application Form

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