Work Experience Application Form June 2015 Please complete the form below, following the instructions carefully. Personal Details Name Base Group Age on 22nd June 2015 Address Shoe Size(for PPE) Post Code Parent/Carer telephone number Parent/Carer name Telephone number Mobile Number Email First Language Type of work Do you know where Yes you would like to complete your work experience? (please circle) If yes, write the name of your 1ST choice place Please inform us of your following choices: 2nd Choice No 3rd Choice 4th Choice If you do not know what you would like to do and require some help, please tick this box Please make any other comments about the type of placement you would like here Your needs Do you have any health/medical issues? (please circle) If yes, please write details in the space provided Yes No Do you have any learning needs? (please circle) If yes, please write details in the space provided Yes No Do you currently get a Yes No taxi to school? (please circle) As part of work experience, you will be expected to travel to your place of work. Please state if there are any reasons why you would not be able to access public transport? For work experience, you will be expected to work the equivalent hours of the usual employer day (approx. 8 hours). Please state if there are any reasons you are unable to work these hours? General questions 1. What is your career and education plan for the future? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 2. Please list the subjects you are currently studying 3. Do you or have you ever had a part time job? (please circle) Yes No If yes, what is the job you do/did have? __________________________________________________________________________________ Give brief details of what the job involves/involved __________________________________________________________________________________ __________________________________________________________________________________ 4. What do you like to do in your spare time? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 5. What strengths, skills or qualities do you have that will be beneficial to an employer? Give examples of why you think you have them? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Please explain in the box below why you would like to complete work experience. Please include information about:      What you think you will learn from work experience? Why it is important for you to go on work experience? Why will you be the best person for the placement you would like to apply for? How you will use this experience to help you to make decisions about your future? What would you like to have achieved by the end of your placement? (Improve confidence, meet new people, get a part time job etc.) Agreement  I am aware that there are limited placements available through the school and in order to gain a placement of my choice, the best option is for me to find my own placement.  Once a placement has been agreed, it cannot be changed.  I will inform the school if my circumstances change. Student Date signature Parent name Parent signature This form should be submitted to Miss Chapman by 28th November 2014. For office use only Date received Staff member Signature