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User Profile
Name:
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Personal Details
Title:
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Surname:
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Forname(s):
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Address:
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Postcode:
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Home Telephone:
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Date of Birth
day:
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1
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month:
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year:
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National Insurance No.:
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Gender:
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Ethnic Origin:
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British
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Any other White Background
White & Black Caribbean
White & Black African
White & Asian
Any other mixed background
Chinese
Any other ethnic group
Caribbean
African
Any other Black background
Indian
Pakistani
Bangladesh
Any other Asian background
Not stated
Do you have a disability or learning difficulty that you wish to declare? Please specify:
Emotional/ Behavioural difficulties
Disability affecting mobility
Temporary Disability
Moderate Learning Difficulty
Mental Ill Health
Dyscalculia
Severe Learning Difficulty
Dyslexia
Profound Complex Disability
Any other Disability or Learning Difficulty
Do you suffer from any of the following medical conditions? If so please indicate:
Diabetes
Psychiatric Disorders
Any Heart Conditions
Deafness
Epilepsy
Vision
Nervous System
Locomotor Syndrome
Are you currently taking any prescribed medications? If yes, please specify:
Are you currently in receipt of any Benefits?:
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Yes
No
(If yes please state):
Upload CV
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Upload Proof of ID
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To enable access to funding to subsidise your learning it is new Government legislation that you prove your identity and eligibility by providing a photocopy or scanned file of any of the allowed file types. Without this evidence, we will not be able to process your application, or accept you onto this course. Please provide a copy of any of the following: - Current full/provisional UK driving licence - Identity Card - Council Tax Bill or payment book (within last 12 months) - Inland Revenue tax notification (not P45 or P60) - Current home or motor insurance certificate (policy holder only) - Disabled driver's pass - OAP travel pass - NHS medical card - Utility bill - within last 6 months - Passport - Birth Certificate
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Education and Employment
Do you hold a Math GCSE, CSE or 'O' Level?:
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Yes
No
Do you hold an English GCSE, CSE or 'O' Level?:
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Yes
No
In line with Government targets anyone who does not hold a grade C or above in either Math's or English qualifications will have priority over those individuals who do.
Are you currently in employment or are you unemployed?:
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Employed
Unemployed
If Employed, What is your current job role?:
If Employed, Please give your employers name and address:
If Employed, Will your employer release you from your work for the duration of the course?:
N/A
Yes
No
If Employed, Will your employer be financing your course?:
N/A
Yes
No
If Employed, How long have been employed by the company? (Date Started if known)
month:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
year:
2008
If Employed, How many people does your company employ?:
1 - 5
6 - 10
11 - 20
21 - 30
31 - 50
51 - 100
101 - 250
251 - 500
501 - 1000
1001 +
If Employed, Whats is the business sector?:
If Unemployed, How long have you been out of employment?
month:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
year:
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
If Unemployed, Please give a brief description of the last employment you were in, what was your job role, and your duties:
If Unemployed, Are you currently registered with a Job Centre?:
N/A
Yes
No
If Unemployed and registered to a Job Centre, please state which centre:
If Unemployed and registered to a Job Centre, please state the name of your advisor:
If Unemployed, Please mark which of the following industry sectors you are interested in looking for employment within:
Hospitality, Leisure, Travel and Tourism
Warehouse
Retail and Sales
Auto Engineering
Construction
Other
None of the above
Do you have a current up to date C.V? (if Yes please upload using the file attachment in the Personal Details group above):
*
Yes
No
Employability Training
Why do you want to undertake Critical Skills Training?:
What do you aim to achieve from this course? (This must be different from above):
Do you have any previous experience with the following (please tick where applicable):
Forklift Truck
Construction
Food Prep
Have you ever held a Forklift / CSCS / Food Hygiene Licence or certificate of any description?:
N/A
Yes
No
Do you currently hold a Forklift Licence?:
N/A
Yes
No
Study Goals and Relevant Experience
Why do you want to learn? (Please tick any reason that applies to you):
*
To learn IT skills
To go onto further learning or training
To learn skills to help in my current job
To improve communication
To gain a qualification
To improve my number skills
Personal Interest
To improve my confidence
To improve my job prospects
To support other learning I'm doing
Please describe your current I.T skills by ticking the most relevant statement:
*
I have never used a computer before.
I have used a computer before with guidance.
I can use a computer for basic tasks without guidance (email, write and print letters)
I can carry out general tasks using a variety of applications, and use a computer regularly.
I can carry out complex tasks fairly confidently and use a computer on a daily basis.
