Work Experience Placement Application Form

School / Post 16 Students aged 14 – 24

V18 01/09/23

Sandwell Council’s Work Experience Scheme

Please return completed applications to:

Work Experience Team Email: [email protected]

Think Local Team,
1st Floor Oldbury Council House,
Freeth Street,
Sandwell,
B69 3DE

Section 1 – Students to complete

Section 2 – School coordinator to complete

Please write using black ink.

Forms must be completed in full using BLOCK CAPITALS.

All signatures are required.

Parents/Guardian to sign Section 1 Part 8

You will be notified of the outcome of your application

Please ensure you have completed all sections including the date the placement is
required, as we are unable to process incomplete applications.

For further assistance please contact the work experience team.

Work Experience Placement Application Form
School / Post 16 Students aged 14 – 24
V18 01/09/23

Section 1 – Students to complete

Date of work experience: From: To:
Do you currently live and/or study in Sandwell? ☐ Yes ☐ No
Part 1 - Personal Details

Forename(s): Surname:
Address:

Postcode: Date of birth: Age:

Email:
Contact number:

Part 2 - Education
School Name and Address

Postcode: Telephone:

Part 3 – Emergency Contact

Name and Address

Postcode: Telephone:

Part 4 - Pre-agreed placements

Please complete the following if a placement has already been agreed by a Sandwell
Council team.
Council employee name:

Email:

Telephone:

Location of placement:

Dates of placement:
Work Experience Placement Application Form
School / Post 16 Students aged 14 – 24
V18 01/09/23

Part 5 - Work Area

From the categories below, please indicate your 3 work choices, 1 being your 1st
preference
1 e.g. Customer Services

2
3
If the 3 options you have chosen are unavailable, are you prepared to accept an
alternative?
☐ Yes ☐ No

Category Work Choice

Administration 1. General administration

1. Day Centres
Adult Social Care 2. Residential homes

1. Youth Service
Children and Learning 2. Employment and Skills
services 3. SAFL (Sandwell Adult & Family Learning)
4. Education support Services
1. Libraries – various across the
Libraries
Borough

Customer Services 1. Customer Services

1. Carpentry
2. Plumbing
3. Plastering,
Construction 4. Gas engineers
5. Multi trade
6. Bricklaying
7. Painting and decorating

1. Multi- disciplinary design including: Architecture,

Urban Design and
Landscape Architecture, Structural engineering,
Building Services
Quantity Surveying
Work Experience Placement Application Form
School / Post 16 Students aged 14 – 24
V18 01/09/23

1. Business regulations
Environmental health, 2. Environmental protection
And Trading Standards 3. Trading Standards

1. Accountancy and Procurement

Finance and Procurement 2. Audit and Revenues and Benefits
3. Finance administration

Public Health 1. Public Health and wellbeing

1. Animal Care
Farm
2. Hospitality

Human Resources 1. Human Resources Development

1. ICT
ICT and Communications 2. Communications

1. Legal administration
2. Committee administration
Legal and governance 3. Elections
4. Registration of births, deaths and marriages
5. Administration of funerals and memorials

1. Horticulture/Gardening/Cemeteries
2. Store and Warehousing
Operational Services 3. Cleaning and Caretaking
4. Fleet Services
5. Countryside Ranger
1. Planning
Regeneration 2. Transport
3. Business Support
Work Experience Placement Application Form
School / Post 16 Students aged 14 – 24
V18 01/09/23

Part 6 - Qualifications

If you have not yet taken your exams, please provide predicted grades
Type of Grade (or Year taken / to be
Subject qualification predicted) taken
e.g. English GCSE Predicted 5 June 2023

Why do you want a work experience placement with Sandwell Council?

Considering the choices you have made, what are you aiming to gain from your work
experience?

What skills do you have in ICT and what software packages are you comfortable
using?

What are your hobbies and interests?

Work Experience Placement Application Form
School / Post 16 Students aged 14 – 24
V18 01/09/23

Please answer the following questions about yourself to help us make sure
that the services are delivered fairly to everyone and assess whether all
sections of the community are equally satisfied with our service.

Part 7 - Ethnicity (Please tick)

☐ English/Welsh/Scottish/Northern Irish/British
☐ Gypsy or Irish Traveller
White ☐ Irish
☐ Other white background, please write:

☐ White and Asian

Mixed or ☐ White and Black Caribbean
Multiple
☐ White and Black African
Ethnic
Groups ☐ Other Mixed/Multiple Ethnic
background, please write:

☐ Bangladeshi ☐ Chinese
Asian or ☐ Indian ☐ Pakistani
Asian ☐ Sikh
British ☐ Other Asian background, please
write:

Black or ☐ African
Black ☐ Caribbean
British ☐ Other Black background, please write:

Other ☐ Arab
Ethnic
☐ Other background, please write:
Group

Gender (Please tick)

☐ Female ☐ Male ☐ Transgender ☐ Prefer not to say

Work Experience Placement Application Form
School / Post 16 Students aged 14 – 24
V18 01/09/23

Disability

Sandwell Council is an equal opportunities employer. The Equality Act defines a

person as having a disability if he/she “has a physical or mental impairment which
has a sustainable and long-term adverse effect on his/her ability to carry out normal
day to day activities”

Do you consider yourself to have a disability? ☐ Yes ☐ No

Do you require any adjustments to support your work placement?
☐ Yes, please specify below ☐ No ☐ Prefer to discuss 1-1

Wherever possible and reasonable we will make adjustments and offer alternatives
to help a young person with a disability throughout the placement process.

Part 8 - Permissions
There may be occasions when you are asked to travel independently or alone with
council staff in vehicles at any site across the borough and outside of the borough.

Do you give your consent for this? ☐ Yes ☐ No

There may be occasions where you are asked to have your photo taken. This could
be used for promotion or marketing material.

Do you give your consent for this? ☐ Yes ☐ No

I confirm that the details I have provided are accurate and correct.
I note that the information on this application form will be held no longer than
necessary and may be further processed or verified in accordance with the Data
Protection Act 1998.

Parent/guardian to sign

Signature Date
Work Experience Placement Application Form
School / Post 16 Students aged 14 – 24
V18 01/09/23

Section 2 – School coordinator to complete

Part 1 - Coordinator Authorisation

Name:
Email:
Direct Telephone number:

Does this young person have a statement of special needs? ☐ Yes ☐ No

Does this young person have Education Health Care Plans/Learning

Disability Assessment?
☐ Yes ☐ No
If yes, please provide a copy.

Does this young person require any needs/support?

☐ Yes ☐ No requirements whilst on placement?

If yes, please give details:

Signed: Date:

Personal Information
Your personal information/data will be used internally within the council to process
your application and for the purposes of securing and providing you with a placement
if you are successful. The council will not share your personal data with third parties
unless required to do so by law.
The contact details you provide will only be used to contact you in relation to
progressing your application and for the purposes of your placement.
The work experience scheme will only hold onto your personal data for a maximum
of 18 months from the date of receipt of your application for administration purposes
and will be deleted after this period.