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Application Form

Surname:		Forename:
Other names:		Date of Birth:
Address:
Post Code:
Telephone no:		Mobile Telephone No
Email Address:		National Insurance No

Date left/leaving school:

Place of further education (if any):

Name of last school:

Date available for work:

Connexions Office (town only):

As part of our Equal Opportunities Policy, all eligible young people will be considered, regardless of race, sex, religion or disability and to ensure the effectiveness of this, we would appreciate you completing the following:

Male Female

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

Do you have a disability or health problem which affects your ability to carry out normal day to day activities?

Yes No

Have you been on a training programme? Yes No

(If so for how many weeks and which training provider)

Transport (bike/motorbike/bus/car):

Do you live on a bus route, if so where are you most able to get to:

PLEASE TICK ALL THE AREAS BELOW WHICH YOU WOULD CONSIDER:

CLERICAL		ENGINEERING

General Admin / Office Duties		Pattern Making (Wood / Metal)
		Fabrication
Accounts / Finance Related		Welder
		Machinist
Receptionist / Customer Service Related		Fitting
		Electrical Installation
Word Processor Operator		Mechanical Maintenance
		Electrical Maintenance
		Drawing Office

DATA PROTECTION ACT
Training Services 2000 Ltd will put the information you give onto a computer to assist with record keeping and for statistical and research purposes.

ACADEMIC QUALIFICATIONS

Subjects taken at school / college (GCSE or equivalent)	Results if known	Predicted grades

What was your favourite subject(s) at school?

What subject(s) did you not like?

JOB SEARCH

Have you had any interviews or applied for other schemes?
Yes No

If yes, give details

Have you had any work experience, either through school, a part-time job, or occupation during holidays? If so, give details:

INTERESTS

What are your hobbies?

Clubs or organisations:

D of E Awards Achieved Bronze Silver Gold

MEDICAL FACTORS

Do you have any history of (please tick):

Epilepsy	Yes No	Heart Complaints	Yes No

Asthma	Yes No	Skin Complaints	Yes No

Allergies	Yes No	Nervous Disorders	Yes No

Hearing Difficulties	Yes No	Colour Blindness	Yes No

Do you wear spectacles?	Yes No	Do you wear contact lenses?	Yes No

Do you have a registered disability?			Yes No

If you have answered YES to any of the above, please give brief details:

Do you require any medication which may be administered during work hours? Yes No

If YES please give details below:

What is your Doctor’s name and address?

Name:

Address:

Fathers Occupation:

Mothers Occupation:

IN CASE OF AN EMERGENCY TRAINING SERVICES 2000 SHOULD CONTACT

Name:
Relationship:
Address:
Telephone No: