Today’s date _____/_____/_____ / School / college:

Contactinformation

Last name / First name / Middle name (if applicable) / Your National Insurance number
Date of birth / Age / Male / Female
/ / /  / 
Town/City and country of birth / Nationality
Languages spoken
Address / Town / city / County / Post code / Home telephone number
( )
Name of parent / carer / Mobile telephone number
Parent / carer signature / Date / ( )
Part of the Career Academy programme involves an internship in a company. ALL companies, for security reasons, ask to see a passport (or full birth certificate if you are a British National) as proof of identity and right to work in the UK.
Do you have a passport (and visa/ permit if you are not an EU Citizen) that will still be valid in August 2012?  Yes  No
Education and community information
Please list the schools you attended between the ages of 11 and 16
Name and address of school/s / Attended from (date) / To (date)
Please list the subject and levelof your qualifications. This should include at least five GCSEs at A*-C including English and Mathematics / Date qualification achieved / Grade awarded
Name of your current tutor / teacher.
Please list the courses or subjects you are currently studying at this school / college.
Are you currently working part-time?
 Yes /  No
If yes, please give details of your employer, address, role and weekly hours.
Please list below any work experience or volunteering activities you have undertaken in the last three years.
Please list any other responsibilities outside school / college that you may have.

General information

Please answer the following questions as fully as possible.
This is an opportunity to display your written communication skills, so please use complete sentences.
Why are you interested in joining a Career Academy?
What do you expect to gain from joining aCareer Academy?
What are your career aspirations?
What is the one thing you’ve done of which you are the most proud? Why?
Where do you see yourself in five years from now?
List three things you do well at the moment.
List three things you would like to learn to do better.
How do you feel about learning new skills?
Describe yourself in three words.
What goals have you set yourself for the next two years?
Please include a reference from someone you have known for more than two years (no more than 100 words). The statement should demonstrate your enthusiasm and commitment to the programme.
Name of referee……………………………………..

Your signature

The above information is true to the best of my knowledge.Career Academies UK and your school / college will use the above information to consider and process your application. It may also use the information to contact you about future events, to invite you to conferences, or to send you newsletters or other pieces of information you may find interesting.
By ticking the box below, you are giving consent to allow any footage and or/photographs to be used for PR, marketing publications and videos by the school/college and Career Academies UK.
The information I have provided on this form is true and correct to the best of my knowledge.
X
Your signature / Date

Please return completed forms to theCareer Academy representative at your school / college.

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