Ealing Apprenticeship Network

Questionnaire

Please type or use black ink. This questionnaire informs us of the skills areas you are interested in and why you want to choose an apprenticeship. Once we have received your form, we will invite you to the next available preparation workshop where we will assess your employability skills. Feedback will be provided at a later date.

Email:
Direct line 020 8825 6234
Post Ealing Apprenticeship Network Team, 4th Floor Perceval House, 14/16 Uxbridge Road,
Ealing. W5 2HL

Information About you

As part of the process, we will need to be in contact with you. Please complete the information below with your up-to-date information including a phone number and email address that works.

Title / Surname
First name

August 2015

Full address
Postcode
Your age
Date of Birth
Home telephone
Work telephone
Mobile telephone
Email address
National Insurance Number

August 2015

Asylum and Immigration Act 1996. Before you commence working you must provide evidence to demonstrate your right to work in the United Kingdom.

Are you eligible to work in the UK? YES NO (clearly indicate the answer)

Do you need a work permit/visa? YES NO (clearly indicate the answer)

2. Advertising Monitoring

We want to know what the best ways to inform people are about the Network. Please indicate where and how you found out about Network apprenticeships. Please choose from the list below or let us know if it was through a different way.

1.  Around Ealing magazine …………

2.  Ealing Council website ………....

3.  Connexions …………

4.  Jobcentre Plus …………

5.  Letter from the apprenticeship team ………...

6.  Other – please specify …………………………………………………………………………….

Read this first.

Being an apprentice is about learning new skills and developing a useful work identity. If you attend the preparation workshop, you will be assessed to see if you are demonstrating the skills and abilities necessary to do an apprenticeship well. The first step in getting a good job is to complete an application form. Completing this Questionnaire is an opportunity for you to practice your developing ‘professional’ communication skills.

With this in mind, please complete the following as carefully and accurately as possible. If you save this document, you will be able to use the information you record on this form for use in future applications.

Section 8 asks you to say what relevant skills you think you have that would be useful in the workplace. For example, you might feel confident about talking on the phone, or you might present yourself in a smart way that would be good in the workplace.

Please check your spelling and grammar as this helps to show employers what you are capable of.

The more fully completed the form, the better the impression you make.

3. Employment, Education and Experience History

Employers will want to know how you have been occupied in the last few years to get an idea of what kind of work and educational experience you have. Please tell us about the jobs you have done, or the schools and colleges you have attended over the past 10 years (if necessary continue on a clearly marked separate page). Please explain the reason for any breaks in employment/school/college dates. If you have not had a paid job before or you have been out of work for some time, write down in this section details of any relevant voluntary work.

Present or Last Job/Work Experience/Volunteering/Educational Setting

Name of organisation you went to school/college, or work(ed) for
Your job title/role

August 2015

Full address
Postcode
Telephone
Employed/ went to school/ college from / to
Notice required (if applicable)
Current Salary (if applicable)

August 2015

Main Duties
Reasons for leaving

Previous Job/Work Experience/Volunteering/Educational Setting

Name of organisation you went to school/ college, or work(ed) for
Your job title/role

August 2015

Full address
Postcode
Telephone
Employed/ went to school/ college from / to
Notice required (if applicable)
Current Salary (if applicable)

August 2015

Main Duties
Reasons for leaving

Previous Job/Work Experience/Volunteering/Educational Setting

Name of organisation you went to school/ college, or work(ed) for
Your job title/role

August 2015

Full address
Postcode
Telephone
Employed/ went to school/ college from / to
Notice required (if applicable)
Current Salary (if applicable)

August 2015

Main Duties
Reasons for leaving

Previous Job/Work Experience/Volunteering/Educational Setting

Name of organisation you went to school/ college, or work(ed) for
Your job title/role

August 2015

Full address
Postcode
Telephone
Employed/ went to school/ college from / to
Notice required (if applicable)
Current Salary (if applicable)

August 2015

Main Duties
Reasons for leaving

If necessary, please continue on a clearly marked separate page.

4. Rehabilitation of Offenders Act 1974

Employers have a duty to protect children, vulnerable adults, people with disabilities and learning difficulties. This section must be answered truthfully and in full. If you answer ‘yes’ to any of the three following questions then you will need to write details about it. It is best to write this on a separate document and submit it with this form.

Posts involving work which brings you in regular contact with children, vulnerable adults, people with disabilities and learning difficulties are exempt from the provisions of the Rehabilitation of Offenders Act 1974. If you are applying for work in this area you are required to inform us whether or not you have any criminal record, convictions, cautions, reprimands, final warnings, bindovers, pending summons or prosecutions whether or not they are regarded as spent. Those appointed to work with children or vulnerable adults will also be subject to a clearance report from the Criminal Records Bureau. Having a criminal record will not necessarily prevent your employment.

Have you ever been disqualified from working with children or vulnerable adults?

Yes / No

If Yes, please give details on a clearly marked separate page.

I am applying for a post which involves working with one of the groups detailed above and I have a conviction or caution for which I attach details on a clearly marked separate page.

Yes / No

If you are applying for other employment, for example, not working with vulnerable groups as above, do you have any convictions or cautions that are NOT SPENT, or criminal prosecution(s)

Yes / No

If Yes, please give details on a clearly marked separate page.

5. Education and Training

Please give details of any education or training you have received. You might have completed courses or exams in English, maths and IT; please include the results of those.

Dates Course title or subject/s studied Qualifications / Certificates

From / To
From / To
From / To
From / To

If necessary, please continue on a clearly marked separate page.

6. Relevant Short Courses Completed

Please give details of any short or part time training courses you have attended which may be relevant.

Course title Dates Certificate

From / To / Yes / No
From / To / Yes / No
From / To / Yes / No
From / To / Yes / No

7. What Apprenticeship Do You Want To Do?

The Network preparation workshop is designed to assess your suitability and readiness to undertake an apprenticeship, so it will help if you can provide information that will enable the team to gain a fuller picture of you. Below are a list of skills areas. Look through the list and choose the skills areas that you are interested in. If you choose more than one, please indicate which ones are your top three choices in order of preference.

Skills Areas YES PREFERENCE

Business and administration
Customer Service
IT (name which area in this field)
Child care
Youth work
Health and social care
Teaching assistant
Construction (which area)
Horticulture
Hairdressing
Motor vehicle
Accountancy
Facilities management/ caretaking
Hospitality
Catering

Skills Areas YES PREFERENCE

Other – please state


8. Why You Want To Be An Apprentice

This section gives you the opportunity to explain why you would like to be an Apprentice.

A)  Now you have selected the skills areas you are interested in please write about your favourite preference. There are questions to help you.

Why have you chosen this as your top preference?

What do you want your future career to be?

Do you have some experience of this skills area already? If so explain what you have done.

Why do you want to do this as an apprenticeship?

What else can you say that will help the team to get an idea of your skills and abilities that demonstrate you could undertake an apprenticeship?

9 Disability & Reasonable Adjustments

Employment legislation is in place to support people with disabilities. The Disability Discrimination Act 1995 defines a person as having a disability if she/he “has long term physical or mental impairment which has a substantial and long term adverse affect on his/her ability to carry out normal day to day activities. If you have a disability, please give details of adjustments you require to participate in the workshop or an interview. You are not obliged to state your disability on this form, but to do so could help us support you better.

Disability

Do you consider yourself to have a disability? / Yes / No
If you have a disability, are there adjustments that we could make to support you at the Screening workshop? / Yes / No
Please give details of adjustments required

10 Signature

It is important to be honest on a job application form and information that you state could be checked to verify your claims. Please note that this form is not a legal document nor a job application. However, the information you have written needs to be as honestly written as possible so that we can assess your suitability.

Date
Signed


11 Monitoring information

Please remember to complete the monitoring information. This page will be detached and not considered for shortlisting..

Applicant Name:
Vacancy Reference No:
Age: (in years) / Date of Birth
I am Female / Male

Ethnic Background

Choose one section from (A) to (E) then ‘cross’/check the appropriate box to indicate your Ethnic Background.

A WHITE
British (25) / Irish (26) / Any other white background please specify (30)
B BLACK OR BLACK BRITISH
Caribbean (8) / African (9) / Any other black background please specify (13)
C MIXED
White and Black Caribbean (15) / White and Black African (16) / White and Asian (17) / Any other mixed background
please specify (21)
D ASIAN OR ASIAN BRITISH
Indian (1) / Pakistani (2) / Bangladeshi (3) / Any other Asian background
please specify (7)
E CHINESE OR OTHER ETHNIC GROUP
Chinese (22) / Any other ethnic background please specify (24)
What is your religion?
Buddhist Christian Hindu Jewish
Muslim Sikh None Any other, please specify
Prefer not to disclose
What is your sexual orientation?
Bisexual / Gay / Heterosexual / Lesbian / Transsexual / Prefer not to disclose

August 2015