Apprenticeship Enrolment Form Template 2020 | Webform Portal

Apprenticeship Enrolment Form

The information collected on this form is to establish your eligibility for funding against an apprenticeship and the suitability of the apprenticeship in line with your job role and will be used to provide the delivery of the apprenticeship.

PLEASE COMPLETE ALL FIELDS HIGHLIGHTED IN YELLOW AND ENSURE THAT YOU READ ALL STATEMENTS

Personal Details

Title: *

First Name(s): *

Last Name: *

Maiden/Any Other Name (if applicable):

Date of Birth: *

Age as at 31 August 2019:

Home Address 1: *

Home Address 2: *

Enter N/A if not applicable

Town: *

Postcode: *

Email Address: *

Home Telephone: *

Enter N/A if Not Applicable

Mobile Number: *

Gender: *

What are your preferred pronouns?

"What are your preferred pronouns?" "Pronouns are the part of speech used to refer to someone in the third person, for example: he, she, they. How would you prefer to be addressed?"

National Insurance Number: *

In case of emergency, please contact:

Emergency Contact Name: *

Emergency Contact Phone Number: *

Emergency Contact Relationship *

Disability is defined by the Disability Discrimination Act as; A physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. The disability could be physical, sensory or mental and must be expected to last at least 12 months. We provide a range of support for learners who have disabilities and learning difficulties. Whether or not you require support, please provide the following information:-

Do you consider yourself to have a disability, health problem or learning difficulty? *

Do you consider yourself to have any additional social needs: *

Learner Support Contd...

Do you require Additional learning support (for example – hearing loop, large computers screen)
Do you require Additional learning support (for example – hearing loop, large computers screen)		If answered yes, please provide details			Support Arrangements Made (To be completed by Assessor)
Do you require Other Support Arrangements (for example – disability, premises modification)	If answered yes, please provide details		Support Arrangements Made (To be completed by Assessor)
Do you have any medical conditions we should be made aware of?		If answered yes, please provide details		Support Arrangements Made (To be completed by Assessor)

About My Residency and Ethnicity

Nationality: *

Is English your first language: *

If no, please state your first language:

Have you lived in the UK or an EEA country for at least 3 years preceding the start of this course? *

If no, please state the country where you have lived: *

Date of entry into the UK (if applicable):

Ethnicity *

If you selected Other please state: *

More about me

Learning Difficulties and Disabilities: *

Please indicate from the list below ALL which may have a significant impact on your education: *

Please confirm if you are aged 19-23 and attached to an Education Health Care Plan: (EHCP) *

If Yes, do you have evidence of an Education Health Care Plan (EHCP)? *

Please select which of the following statements apply (one of more may apply) *

No member of the household in which I live (including myself) is employed The household that I live in includes only one adult (18 or over) There are one or more dependant children (aged 0-17 years or 18-24 years in full time education or inactive) in the household None of these statements apply I confirm I wish to withhold this information

Identification

You will be required to provide valid Identification - are you able to provide this now? *

Please Take a Photo of your ID: *

Passport, Drivers Licence, Birth Certificate, National ID Card

Once we have checked your ID the photo will be blurred so that no personal information is retained.

Previous Education and Training

Some qualifications, previous experience or learning may exempt you from parts of your apprenticeship. For example prior qualifications may count towards specific elements of your apprenticeship including modules or units and Functional Skills. Other experience may support towards chosen units or modules and inform us of the type of learning you will need to complete.

(A) You must provide details of your highest prior qualifications.

(B) If you have a certificate you need to provide a clear copy of this.

Previous Highest Qualification: *

Please list any qualifications you have achieved, together the with grades gained from within the UK - please note, that evidence of grades will be required.

Subject	Qualification Type	Grade/Level	Date Achieved

GCSE English Grade / Functional Skills Grade *

Please only enter your grade if you are able to provide evidence via the below Photo field. If you do not have either qualification please enter N/A.

Please upload a photo of your English GCSE / Functional Skills Certificate

Date Awarded

GCSE Maths / Functional Skills Grade *

Please only enter your grade if you are able to provide evidence via the below Photo field. If you do not have either qualification please enter N/A.

Please upload a photo of your Maths GCSE / Functional Skills Certificat

Date Awarded

Employment Details

Are you currently in paid employment? *

Employer's Name: *

Employment Start Date: *

What is your job title/Role? *

Do you hold a contract of employment? *

Yes No

How long have you been employed? *

How long have you been in your current role: *

Annual Leave (days) *

Not including bank holidays

Please state your total weekly contracted hours of employment *

This is the number of hours you are contracted to work each week and should be contained on your contract of employment. Speak to someone within your organisation for guidance.

Do you require this Apprenticeship as part of: *

A new job that requires new knowledge and skills or An existing job role where the individual needs significant new knowledge skills and behaviours

Please provide details of your working pattern/Shifts if applicable (i.e. Mon-Fri 9am-5pm etc) *

Please enter N/A if Not Applicable.

Employer's Contact Name *

Employer's Contact Phone *

Employer's Contact Email *

IF YOU ARE NOT CURRENTLY EMPLOYED YOU WILL FIRST NEED TO APPLY FOR AN APPRENTICESHIP VIA OUR APPRENTICESHIP RECRUITMENT TEAM WHO WILL BE IN TOUCH SHORTLY.

How we use your personal information:

Your personal information is used by the DfE (Department for Education) to exercise its functions and meet its statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009 and to create and maintain a Unique Learner Number (ULN) and a Personal Learning Record (PLR).

Your information may be shared with third parties for education, training, employment and well-being related purposes, including for research. This will only take place where the law allows it and the sharing is in compliance with Data Protection Legislation. You may be contacted after you have completed your programme of learning to establish whether you have entered into employment or gone onto further training or education.

You may be contacted by the English European Social Fund (ESF) Managing Authority (or agents acting on its behalf) to carry out research and evaluation to inform the effectiveness of training.

You may also be contacted by us for other purposes by ticking any of the following boxes *

Phone Email Post No Contact

Further information about how the DfE (Department for Education) or how we makes use of and has access to your personal data, details or organisations with whom we regularly share data, information about how long we retain your data, and how to change your consent to being contacted, please visit: https://www.gov.uk/government/publications/esfa-privacy-notice

Data Protection

The Licensor will hold all Personal Data supplied by the User to the Licensor in accordance with the provisions of the EU General Data Protection Regulation 2016/679.

Confidentiality

The User undertakes to the Licensor to: Keep confidential all the Licensor's Confidential Information and not to disclose any of the Licensor's Confidential Information to any person; Use the Licensor's Confidential Information solely for using the Software for the Permitted Use in accordance with these Conditions.

The provisions of the above shall not apply to the extent that the Licensor's Confidential Information is: In the public domain; Or trivial or obvious.

For the avoidance of doubt, the Licensor's Confidential Information shall not be deemed for the purpose of the above to be in the public domain if it is known by other users as a consequence of the use by such persons of the Software. The Licensor shall keep confidential all information inputted by the User in the course of using the Software for the Permitted Use and shall not disseminate such information to any third parties (except the relevant Centre), save as required by law.

Declaration

I confirm that I have checked the information on this form and it is correct and I have read and understood the above statements.

Apprentice Signature: *

Tap or click on the signature above to sign

YOU HAVE NOW COMPLETED PART A OF YOUR APPRENTICESHIP ENROLMENT FORM.

PLEASE SUBMIT AND WE WILL BE IN TOUCH.

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