Work Placements

Work Placements

Work Placement Request/Application Form

Section 1: Your details

Name*

Date of birth*

Address*

Please include postcode

Contact number*

Email address*

Section 2: School/College/University/Supporting Organisation contact details

Organisation name*

Organisation contact name*

Organisation contact number*

Organisation email adress*

Section 3: Placement details/preferences

Type of placement you are applying for*

Preferred start date*

Preferred duration*

Hours available to work per week/day*

Preferred location*

Do you hold a current DBS certificate?*

(This is a check of your criminal record carried out by the Disclosure and Barring Service)

Section 4: Supporting statement

We ask that you to provide some information about your application, this could include why you think you are suitable for a placement, what you think you might get from the placement, or future career plans.

If you’re attending school or college ask a teacher or advisor for help if you need it, if you don’t attend school or college please ask someone who can act as your referee to explain why you’re suitable for a placement.

What types of skills and knowledge would you like to get from your placement?*

To provide appropriate support during the work placement, is there any additional information or specific support Norse need to be made aware of?*

Tutor/Referee Name*

Section 5: Objectives

Objectives*

The work placement should provide you will a range of new experiences, skills and knowledge. What objectives would you like to achieve whilst on your placement?

Section 6: Declaration

Some of our placements are positions that are exempt from the provisions of the Rehabilitation of Offenders Act 1974 that allow convictions to be regarded as ‘spent’.

Consequently, all applicants must state whether they have any convictions, cautions or bind-overs. Any information will be treated with the strictest confidentiality but may need to be taken into consideration when considering placements.

I have read the statement above and (please tick whichever statement applies):

I have nothing to declare

I have information to declare and agree to provide Norse with the relevant details

I confirm that the information given on this application is correct. I understand that any false may result in my application being refused or my placement being cancelled.

Parent or guardian’s name

If under the age of 18

Full Name (Declaration)*

Date*

Send me a copy of my responses

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