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Work Experience Request Form-2

The Work Placement Request Form is designed for individuals seeking work experience placements, requiring personal information and details about availability. Applicants must submit the form along with an up-to-date CV and will be contacted regarding placement availability. The form also includes sections for emergency contacts and information about any disabilities that may require accommodations.

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ibbynittu123
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4 views

Work Experience Request Form-2

The Work Placement Request Form is designed for individuals seeking work experience placements, requiring personal information and details about availability. Applicants must submit the form along with an up-to-date CV and will be contacted regarding placement availability. The form also includes sections for emergency contacts and information about any disabilities that may require accommodations.

Uploaded by

ibbynittu123
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Work Placement Request Form

Once you have completed this form, please send it (along with an up-to-date CV, if you
have one) to the area you are interested in. Please see our website for further details of
the areas currently offering placements. Upon receipt of the application form, a member of
staff will contact you to let you know if they can offer you a placement on the dates you
have requested. Please note numbers of places are limited and there is no guarantee that
the service area can accommodate the request.

Please complete the following information.

About You:

Mr Miss Mrs Your Date of Birth:

First Name: Surname:

Your Address:

Your Telephone Number:

Your Email Address:

Emergency Contact Details

Name:

Telephone No:

About Your Co-ordinator

Please provide details here of your work experience co-ordinator or support worker (if
applicable). If you do not have a co-ordinator, please leave this section blank.

Co-ordinators Name:
School/Company Address:

Telephone Number:
 What dates are you available for your placement?

From ___________ to ___________

 What do you hope to gain from your work experience placement?

 Are you (please tick):


A school pupil  A student  An adult 

 Do you have a disability?* Yes  No 

If Yes, please tell us the nature of your disability and any adjustments you may need in
order to participate fully in your work placement*:
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
………………………………………………………………………………………………………....
…………………………………………………………………………………………………………

*Please note that any details you provide about your disability will be handled in the
strictest of confidence. However, we may need to pass this information on to your work
experience supervisor to ensure that you receive the right support during your placement.

Date………………………

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