Personal Details
If anything does not apply, please ignore.
Name
Address Line 1
Address Line 2
Address Line 3
Town / City
County
Postcode
Date of Birth
Age (years)
Age (months)
National Insurance Number
Telephone Number
Mobile Number
Email Address
Name of Next of Kin
Address of Next of Kin
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Do you hold a current driving licence?
Yes No
Do you have access to a car for work?
Yes No
Do you need a work permit?
Yes No
Have you suffered from any of the following:
Asthma, hearing loss, diabetes, colour blindness, epilepsy, skin complaints, hayfever, migraine or allergies.
Yes No
If Yes, please give details:
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In the past 3 years have you suffered from any prolonged period of sickness (i.e. longer than 7 days)?
Yes No
If Yes, please give details:
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Equal Opportunities
The information requested below is only used to measure the effectiveness of our Equal Opportunities Policy, and will
not be taken into account in the selection process. Please provide details about yourself by ticking the appropriate boxes.
Are you:
Male Female
Do you have any disabilities:
Yes No
If Yes, please give details:
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Do you receive any disability benefits?
Yes No
I would describe my ethnic origin as (please tick):
Black African
Chinese
Pakistani
Black Caribbean
Bangladeshi
White
Black Other
Indian
Other
Nationality
Education, Training and Qualifications
Please give details of educational qualifications you have obtained from school, college, university, etc. Please include
School/College/University, Dates studied, Subjects Studied and Qualifications (grade achieved/expected).
School/College/University
Date From/To
Subjects Studied
Qualifications (include grade / expected grade)
Have you attended any other Training Organisations?
Yes No
If yes, please give details below:
Name of Training Organisations
Course Title / Qualification
Completed Yes / No
Duration Years Months
Please give details below of any other courses / qualifications you have studied (e.g. health and safety,
CLAIT, First Aid, etc.)
Employment History
Please list most recent employment, including part-time, weekend and/or evening work. Please give Employers Name,
Dates, Duties and Reason for Leaving.
Employers Name
Dates
Duties
Reason For Leaving
Miscellaneous Information
What subject are you interested in studying at ITEC?
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Please give details of your interests and hobbies:
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Where did you find out about ITEC?
School
Newspaper Advert
Connexions
Careers Fair
Employer
Friend
Other
If other, please specify:
Are there any other relevant details you wish to add in support of your application?
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References
Please give the name and addresses of two people who we could contact to give references with regard to your application.
One of these should be your school Head Teacher if you are leaving school or have left within the last year. Please provide
their name, address and position held.
Name of Referee 1
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Address of Referee 1
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Position Held by Referee 1
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Name of Referee 2
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Address of Referee 2
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Position Held by Referee 2
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By clicking this button, I confirm that the details contained in this application form are a
true and accurate account of my personal details, qualifications and experience.