RESTRICTED ACCESS–PERSONAL DATA

/ To be completed by HoL
Candidate no

Work Experience Placement form

Before completing this form, please read the notes for guidance for information on our criteria requirements and details on our selection process.

All sections must be completed in a brief and informative manner. If completing this form by hand, please ensure that your handwriting is legible.

Section one - Personal details

Gender
Last name
First name(s)
Date of birth
Address
Home telephone number / Mobile phone number
Email address
Name of school
Telephone number of school

Section two – Education and Learning

Please tick the boxes for the subjects you are currently studying and those you have completed, in the table below. Use the blank rows for any subjects not listed.
GCSE / AS Level / A Level / Other
English Language / / / /
English Literature / / / /
Mathematics / / / /
History / / / /
Geography / / / /
Biology / / / /
Physics / / / /
Chemistry / / / /
Politics / / / /
Economics / / / /
IT / / / /
Religious Education / / / /
Art / / / /
Music / / / /
Drama / / / /
Media Studies / / / /
Design and Technology / / / /
Food Technology / / / /
French/German/Spanish / / / /
Business Studies / / / /
/ / /
/ / /
/ / /

Section three – Skills and experience

Drawing from all aspects of your life (school, general interests and any other work experience) tell us what skills you have learnt and used. Please provide examples, using a maximum of 150 words.

Section four – Future career

What are your aspirations for the future? Why do you wish to pursue these goals? Use a maximum of 150 words.

Section five – Why the House of Lords?

Please tell us why you want to complete your work experience at the House of Lords. Do you have any specific areas of interest? Use a maximum number of 150 words.

Section six – Preferences

Indicate in the table below your office of preference. Please make one choice by ticking in the relevant box.
Further details about each office can be found at:
/ Clerk of the Parliament’s Office
/ Committee Office
/ Hansard
/ Human Resources Office
/ Information Office
/ Journal Office
/ Legislation Office
/ Library
/ Printed Paper Office
/ Property & Office Services

Please select your preferred dates (see notes for guidance on availability) by ticking the relevant boxes. When possible, we will endeavour to accommodate these dates, but a degree of flexibility may be necessary. The dates listed below may be subject to change. Successful candidates will be offered a period of one week or less.

Selection / Availability
/ 08 June – 12 June 2015
/ 15 June – 19 June 2015
/ 22 June – 26 June 2015
/ 29 June – 03July 2015
/ 06 July – 10 July 2015

Section seven – confirmation

Please sign and date this document, confirming that the House of Lords work experience policy has been read in full, you have not previously obtained work experience in Parliament and that all the information provided is current and accurate.
Signature: / Date:

Section eight – checklist

Please tick the following boxes, so that you are sure that all sections of this form have been completed.

/ Section One
/ Section Two
/ Section Three
/ Section Four
/ Section Five
/ Section Six
/ Section Seven

Thank you for taking time to complete this application form. Please forward to or, Human Resources Office, Millbank House, House of Lords, London, SW1A 0PW. If using the postal system, due to security screening of all in-coming post, please allow additional time for your application to reach us. The closing date for Work Experience Placement Scheme 2015 is 11.59 pm on Monday 5 January 2015. Applications received after this deadline will not be accepted.