Coventry Boot Camp Application Form March 2016

What is BootCamp?

BootCamp is a three week intensive programme which aims to engage and support young people who are furthest from the workplace and may not be ready for mainstream training or employment.

What ‘campers’ can expect to achieve from the programme:

To have improved skills and confidence
To achieve the best possible outcome that is right for them through education, further training, apprenticeships and employment
To improve employability
To work as part of a diverse team
To improve their independent living skills, including how to manage a home and to be a good neighbour
To be an effective and productive member of a team
To create and expand a CV and add more skills and experience
To Improve communication skills and confidence
To identify their own skills and abilities
Know where to go for further help and advice
To challenge themselves and do their best

The main partners:

Whitefriars Housing
Midland Heart Housing
Orbit Heart of England
Henley College
City College
Right Steps
Coventry City Council Employment Service
Job Centre Plus
Integrated Youth Support Service
West Midlands Fire Service
West Midlands Police

And Valley House are delivering the programme

If you tick yes to all of the questions below, then you could be offered a place on Coventry BootCamp!
Question / YES / NO
Are you aged between
16-24 years old?
Are you not in education, training or employment?
Are you living in Coventry?
Are you living in a Whitefriars, Midland Heart or Orbit property?
Do you want a job or interested in training?
Will you commit to a 3 week programme?
(Weekdays only)
*DO YOU WANT TO RECEIVE A HIGH STREET VOUCHER WITH A VALUE OFUP TO £50?
If you want to do BootCamp but don’t answer yes to all of the above, then just contact Colin Hooper and he’ll be able to advise you
*Up to £50 Shop4One voucher will be given depending on
Attendance / Punctuality / Participation / Attitude to Learning / Completion of Learning Journals / Completion of programme. The amount could differ for everyone attending the programme

Important Dates

Why Join BootCamp?

What others have said about BootCamp...

Coventry Boot Camp isa 3 week course

Friday 4th March 2016- Thursday 24th March (does not include weekends)

9.30am- 4.00pm

You must be able to commit to the entire course and attend every day for the duration of the BootCamp. If you are unable to attend the entire course, please do not attempt to apply on this occasion.

Referrer Details:

Name:
Job Title:
Organisation:
Address:
Postcode:
Contact number:
e-mail address:

Personal Details:

Name:
Address:
Postcode:
Contact number:
e-mail address:
Date of Birth:

Your Child/ren’s Details (if you are a parent):

Name of child/ren
Child/ren Date of Birth:
Do you have parental responsibility of this child?
Where will the child/ren be whilst you are at BootCamp?
Do you have Social Care involvement?

Your emergency contact details (who do we contact in an emergency):

Name:
What is this person’s relationship to you?
Mobile telephone number:
Landline telephone number:
Address:
Postcode:

What is your residence type? Please tick below:

Rented / Midland Heart / Stone Water (formerly called Jephson)
Whitefriars / Private Landlord
Orbit Heart of England / Guinness Northern Counties
Private / Please specify
Other / Please specify
Owner Occupier / Home Buy/Percentage Buy Scheme
Other / Please specify

Are you currently employed, in training or on a work programme? (Please tick those that apply to you)

Yes / No
How long have you been unemployed
Are you on any benefits? / Yes / No
What benefits? / Incapacity Benefit / Job Seekers Allowance
Universal Credit / Employment Support Allowance
Income Support / Other (please state)
How long have you been on benefits? / More than 6 months / Less than 6 months
If you are employed, in training or on a work programme?
Please give details
Please give details of any previous employment with dates, include any volunteering and work experience:
What type of skills and/or abilities do you feel that you currently have to offer potential employers (good IT skills, good telephone manner for example)
Please think about what type of job would you like in the future. So that we can find a placement for you that is more likely to succeed.
What barriers do you feel that you face in obtaining a job or training? Qualifications, knowledge, confidence, etc

Please give details of any school or college you have attended even if you did not complete the course and/or did not successfully pass any qualifications and/or you are still currently studying.

School/College/Training Provider / Dates Attended / Subject(s) / Level / Qualification Obtained

Criminal Convictions

A criminal record may not automatically prevent you from attending Boot Camp. We need this information to make sure that we can find the right placement or training for you.

Have you ever been convicted of a criminal offence which in not spent under the Rehabilitation of Offenders Act 1974? / Yes / No / Unsure
Do you have any previous convictions, spent or not within the act including any citations, reprimands, final warnings, bind-over or any convictions from overseas? / Yes / No / Unsure
If yes or unsure please give details:

Equal Opportunities

We will not discriminate on the grounds of age, disability or impairment, employment status, gender, gender reassignment, home address, marital status, nationality, national origin, race, religious belief, responsibility for dependents, sexual orientation or trade union membership.

Ethnic Group
1) Choose one section from a) to e).
2) Then select the box that best describes your cultural or ethnic background.
3) If you select the last box within any category, please detail your ethnicity in the space provided underneath. / a) White
British
Irish
Any other white background
Please state / b) Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background.
Please state
1)c) Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background.
Please state. / d) Black or Black British
Caribbean

African
Any other black background.
Please state. / e) Chinese or other ethnic group
Chinese
Any other
Please state.

Sexual Orientation

Heterosexual / Straight / Gay Man / Lesbian
Bisexual / Questioning / Rather not say

Gender

Female / Male / Trans
Questioning / Rather not say

Religion

Buddhist / Christian / Hindu
Jewish / Muslim / Sikh
Other / None / Rather not say

Disability

Do you consider yourself to have a disability? / e.g. Dyslexia
SEN Statement / Yes / No
If yes, please give details
Do you take any medication (this information will be kept confidential). / Yes / No
If yes, please give details
Is there any particular support you would require or information you would like to share with us about any disability or health condition? It is important we know this information so that we can support your future opportunities.
Do you have any dietary requirements?
If yes, please list

Date Protection:

Photography/Filming/Media Interviews Consent Form

I agree to allow my image or footage of, and any other related materials, including name, likeness image, voice and interview performance to be used as follows:

In publications, documents and display material produced by the Coventry Boot Camp Project

On partner agencies, dedicated Coventry Boot Camp website, YouTube and/or Facebook page and other social media

In the media, including newspaper, magazine articles, television and radio productions

Promotions within the Chartered Institute of Housing (CIH), National Housing Federation (NHF) and other similar organisations representing partnerships organisations

I agreto be involved with the photography and publicity as explained above:

I do not wish to be involved in any photography or publicity as explained above:

Your name:Signature:Date:

Under the 1998 Data Protection Act, your rights include:

In accordance with principle 1 of the Act, your consent (to the publication of your or your child/wards photo) can be withdrawn at any time.
In accordance with principle 2 of the Act, your photos will not be used for any other purpose without your future consent.