APPLICATION FORM FOR APPRENTICESHIPS

Derwent Training Association

Important Information! This application form could be submitted to potential employers - please complete all sections.

Remember! Please enclose your latest CV with this application form!

1. Where did you hear about Derwent Training Association
Please tick appropriate box(es) Connexions Careers Convention Employer School Advertisement DTA Website
Other (please state which)
2. Type of job /training
Do you have a Connexions Personal Advisor?
If yes, please name
Please select which occupational areas you are applying for Welding / Fabrication Mechanical Engineering Electrical Engineering Maintenance Engineering Electronic Engineering
3. Personal details
Last Name
First Name(s)
Are you
Age
Date of birth / DD / MM YYYY
Address
Street Address

Address Line 2

City

County / Region

Post Code

Country
Telephone no.
Mobile no.
Email Address
National Insurance no. (if known)
Unique learner no. (if known)
Do you have your own transport?
To help us see how our equal opportunities policy is working, please tell us to which of these groups you belong: White British Black African Black Caribbean Black other Indian Pakistani Bangladeshi Chinese White other
4. Emergency Contact Details:
Name
Relationship
Contact Number
5. Education (School)
Name and address of most recent school
From (year)
Date leaving / left school / DD / MM YYYY

Qualifications being studied for or already taken

Subject	GCSE, A-level, GNVQ, NVQ or other type of qualification	Grade expected	Grade achieved	Year exam taken

6. Education (College)
Name and address of college or sixth form attended
From (year)
Date leaving / left College or sixth form / DD / MM YYYY

Qualifications being studied for or already taken

Subject	GCSE, A-level, GNVQ, NVQ or other type of qualification	Grade expected	Grade achieved	Year exam taken

7. Previous training
If you have previously done any training, including Apprenticeships or any other training, please give details.

Learning provider's name Type of job / training From (month / year) To (month / year)
8. Previous work experience / employment

Please give details of previous school / college-based work experience, full or part-time employment other than Apprenticeships or voluntary work.

Company name and address	Type of work experience / employment	From (month / year)	To (month / year)

9. Additional information
Use this space to give additional information to support your application, e.g. activities in and out of school, and other relevant achievements such as positions of responsibility.
10. Health record
In order to help Derwent Training Association place you in an appropriate job or training placement and to provide you with any additional support that you may need, please answer the following questions. (If you require any assistance in completing this section please contact Derwent Training Association). Do you suffer from any of the following? (Please select either YES or NO)
Epilepsy
Astma / bronchitis
Colour blindness
Arthritis / rheumatism
Learning difficulties
Skin complaints
Hearing impairment
Diabetes
Dyslexia
Physical injuries to back, arms or legs
Heart problems
Visually impaired
Other (if yes please specify below)
11. ASE assessment
As part of the application process you will be asked to take an ASE assessment. Have you already done this within the past 12 months?
If YES, with which learning provider?
When? Month
Year
Data Protection Act 1998: The information on this form may also be shared with other learning providers, Connexions and potential employers. Please tick this box if you do NOT want your details to be passed on. No
Help us to process your application quickly!

Please fill in as much of this form as you can, all sections must be completed for us to process your form.

Signature:

Date: / DD / MM YYYY

Learning provider's name	Type of job / training	From (month / year)	To (month / year)

APPLICATION FORM FOR APPRENTICESHIPS

APPLICATION FORM FOR APPRENTICESHIPS

Derwent Training Association

1. Where did you hear about Derwent Training Association

2. Type of job /training

3. Personal details

4. Emergency Contact Details:

5. Education (School)

6. Education (College)

7. Previous training

8. Previous work experience / employment

9. Additional information

10. Health record

11. ASE assessment

Help us to process your application quickly!