Multi-Agencytrainingapplicationform

PeterboroughSafeguardingChildrenBoard

Multi-agencytrainingapplicationform

COURSEDETAILS(PleasecompletealldetailsinBLOCKCAPITALS)
Coursetitle:
Coursedate(s) / Times
Venue
APPLICANTDETAILS
Name / Job Title
Department
Employing Agency
WORK ADDRESS
Workaddress(pleasegive fulladdressforsendingconfirmationdetails)
Postcode
Emailaddress
Worktel.no. / Shortnoticetel.no.
Additionalorspecificneeds (dietary) : / Additionalorspecificneeds (mobility/learning):
APPLICATIONS FOR COURSES AT LEVEL 2 AND ABOVE
CompletionofaLevel1SafeguardingChildrencourseisapre-requisitetoLevel2andLevel3courses inthisprogrammeandshouldhavebeenundertakeneitherwithusorthroughtheapplicant’sown agency.Pleaseensurethattheabovenamedapplicantmeetstheserequirements.
TheabovenamedapplicanthaspreviouslyattendedLevel1SafeguardingChildrenTraining
Yes / Ifyespleasegiveapproximatedate
Agencyprovider
NoIfnowecannotprocessthisapplicationforLevel2/Level3training.
Ethnicity:
White British
White Irish
Any other White background
Gypsy/Roma
Caribbean
African
Any other Black background / Traveller of Irish Heritage
Indian
Pakistani
Bangladeshi
Any Other Asian Background
White & Black Caribbean
White & Black African / White & Asian
Any other mixed background
Chinese
Any other ethnic group
Prefer not to say
DECLARATION
1. IconfirmthatIhavereadtheattendancecriteria andlearningoutcomes forthiscourseandbelievethatIwillsignificantly benefitfromthislearning.
2. Iwilltakeallnecessarystepstoensurethatthelearningoutcomesarereinforcedintheworkplace.
3. Iagreetoprovide,onrequest,PeterboroughSafeguardingChildrenBoardwithpost-coursefeedbackinrelationtothe courseitselfandsubsequentworkplacedevelopment.
4. IunderstandthatplaceswillbeallocatedbyPeterboroughSafeguardingChildrenBoardand,shouldIbeallocatedaplace, agreetobringtheconfirmationletterwithmeonthefirstdayofthecourse.Iunderstandthatmydetailsmay besecurely andconfidentiallyretainedbyPeterboroughSafeguardingChildrenBoardforstatisticalandinformationpurposesonly.
5. I agree to pay Peterborough Safeguarding Children Board the course fee as described in the Peterborough Safeguarding Children Board Approved Training Programme 2014.
6. I agree to reimburse Peterborough Safeguarding Children Board for late cancellation or non-attendance as described in the Peterborough Safeguarding Children Board Approved Training Programme 2014-2015.
Signature / Date
Your application will not be considered without line manager approval.
INVOICE/PAYMENTDETAILS
Please completedetailsbelowevenifyouarenotpayingforcoursefeesaswemay needtoinvoice yourdepartment/organisationforlatecancellation/non-attendancecharges
Name / Organisation/Agency
Contactaddress(ifdifferentfromapplicant)
Postcode
CostCode
APPROVAL
I authorise this applicant to attend this course and agree I will take all necessary steps to ensure that the learning outcomes are reinforced in the workplace.
Line Manager Signature / Line Manager Name (Print) / Date
Pleasereturncompletedformto:
Business Support Officer (PSCB Training), 1st Floor, Bayard Place, Broadway, Peterborough, PE1 1FB or email to