learner application form

LLeeaarrnneerr AApppplliiccaattiioonn FFoorrmm

Successful applicant: Yes No

Induction Date:…………….. Attended: Yes No www.tpmnow.co.uk

Date Entered onto CRM: ______________ Entered by: ___________________

T:\Company Secretary\QA File\QA Procedures\Recruitment Department\Procedures 11.12\Learner Application Form Nov 11.doc of 4

I am normally and lawfully resident in the UK and have been for the last 3 years. Yes No If No! see eligibility requirements, notes to be made by the BDC

4. Equality and Diversity. This will help us monitor our performance, in striving to be an Equal Opportunities Company and address aspects of racial under-representation within our organisation.

(Tick the appropriate box to indicate your cultural/racial origin.)

31 English / Welsh / Scottish / Northern Irish / British 32 Irish 33 Gypsy or Irish Traveller 34 Any other White Background 35 White and Black Caribbean 36 White and Black African 37 White and Asian 38 Any other Mixed / Multiple Ethnic Background 39 Indian 40 Pakistani

41 Bangladeshi 42 Chinese 43 Any other Asian Background 44 African 45 Caribbean 46 Any other Black / African / Caribbean Background 47 Arab 98 Any other Ethnic Group 99 Not Provided

1. Personal Contact Details: Title: (Mr. Mrs. Miss. Ms.)

First Name: Middle Name: Surname: Address: Post Code:

……………………………… ……………………………… ……………………………… ……………………………… ……………………………… ……………………………… ………………………………

D.O.B. Home Telephone: Mobile Telephone: E-Mail Address: Name of Next of Kin: Telephone Number: National Insurance N

o:

………………………………… ………………………………… ………………………………… ………………………………… ………………………………… ………………………………… …………………………………

2. Training Course you wish to join: Please tick one box

Hairdressing Barbering Business Administration Children’s and Young People’s Workforce

3. tpm welcomes applications from people living with a physical, sensory or learning disability or difficulty. It is our

express desire to support your access to training and individual needs in accordance with our ‘Disability Statement’. Please be honest and give as much detail as you can about your needs or requirements: You can discuss any worries or concerns with your interviewer who will be happy to help.

a. Do you have a Physical, Sensory or Learning disability or difficulty?

Yes

No

Unsure

b. Do you have any difficulty with reading writing or maths?

Yes

No

Unsure

c. Do you require any other form of assistance, adaptation or learning support?

Yes

No

Unsure

d. Do you require support with reading, writing or maths?

Yes

No

Unsure

e. Please give details of the type of support you feel you might want or need.


5. Qualifications / Examinations taken:

Qualification /Subject Taken

e.g. GCSE / Maths Date Obtained Grade

Achieved School / 6

th Form College

6. Previous Employment / Further Education: e.g. NVQ, Training, Work and/or Voluntary Experience:

Training Course/ Job Title / Role Dates from - to Completed Y/ N

Training Provider / College / Awarding Body / Agency

7. Other Current Training.

Are you currently receiving any other form of training or attending courses at university, college or another training provider? (i.e. more than 16 hours per week)

YES

NO

Give details here of where and when)

8. Please give the name and address of the last school you attended.

9. Please tell us why you wish to take Training in the occupation you have chosen:

10. Have you undertaken a Degree Yes No Did you complete the full qualification Yes No Course undertaken with ………………………………………….. Subject Area …….…………………………….…………….. (College or University)


12. REHABILITATION OF OFFENDERS ACT - HEALTH AND SOCIAL SERVICES EXEMPTION. (In relation to Child Care courses only)

tpm uses stringent measures to safeguard young people and staff within the organisation and similarly in supplying teaching and assessment services to employers.

Because of the nature of the work for which this application is being made, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. You are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act and, in the event of employment; any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to an application for posts to which the order applies.

(a) Have you ever been convicted of a criminal offence (other than minor traffic offences)? YES NO (b) If you answered YES above, please give details of the conviction on a separate sheet and attach in a sealed

envelope marked ‘Confidential’. (Ask our receptionist for an envelope if you need one) (c) Are there any current criminal proceedings against you? YES NO

Signature: Date:

tpm STAFF USE ONLY BEYOND THIS POINT:

Learning Record Service (LRS): Verification Evidence:

2. Passport (Record Passport Number)

3. Driving Licence (Record Licence Number)

4. ID Card / other form of National ID (Record ID Number)

5. National Insurance Card (Record Card Number)

6. Certificate of Entitlement to Funding (Record Certificate Number)

7. Bank/Credit/Debit Card (Record Bank/Branch Name)

8. Unknown (Application will not be processed further until one form of MIAP Information is produced)

9. Other Form of Evidence (Please state)

I confirm I have sighted and validated one of the above as required by LRS: BD Consultant: Signature: Date:

13. Do you have a criminal record? Please tick. YES (See 13a below) NO

13a. Please give details of the conviction on a separate sheet and attach in a sealed envelope marked ‘Confidential’. (Ask our receptionist for paper and an envelope if you need it).

14. Applicant Declaration and Authorisation for use of personal Information.

I the undersigned confirm that the information given above in this Application is true to the best of my knowledge. I understand that the information provided by me in this application and the associated Initial Assessment and screening documents may/will be shared with other tpm teaching and assessment staff in order to support and facilitate teaching and learning. Signature:

Date:


BD Consultant: Signature: Date:

QUALITY / CLAIMS ADMINISTRATION:

Programme Type (Tick one):

Sector Subject Area (Tick one): Sector Subject Level (Tick one):

Intermediate Apprenticeship Hairdressing Two

Advanced Apprenticeship Barbering Three

Business Administration

CYPW

Details of interviews arranged / Reasons for unsuccessful Interviews and detail of referrals:

Interview/s held at: Date

Arranged: Successful Reason/s Unsuccessful at Interview and Referral Details

Yes / No Yes / No Yes / No Yes / No

INTERVIEWERS NOTES

Eligibility Confirmation / Application and Initial Assessment Check

I confirm that thorough checks have been carried out on the Learner’s previous experience (Degree / FE / NVQ Qualifications / Training and Work Experience) taking into account the requirements for non eligibility for WBL funding (see guidance below).

Following a full recruitment process (which included Learner interview; APLA information; Employer / Manager interview; Initial Assessment and skills scan) I the undersigned confirm that the above named learner will be entitled to commence the following training:

Eligibility for Key Skills Exemption The learner is exempt from ICT key skills examination and portfolio (A – C) The learner is exempt from COMM key skills examination & portfolio (A – C) The learner is exempt from AON key skills examination & portfolio (A – C)

The learner is exempt from ICT key skills examination but will complete the required portfolio (D – E)

The learner is exempt from COMM key skills examination but will complete the required portfolio (D – E)

The learner is exempt from AON key skills examination but will complete the required portfolio (D – E)

The learner is not exempt and will work towards key skills examinations and portfolio (D – E L2)

Signature: Date:

Applicants not eligible for WBL funding are as follows:- Graduates, except for those who have participated in the New Deal and are in the eligible client group, or engaged in HE programmes, or who attend school or FE college full time which is funded under another funding stream

learner application form

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