First Name *
Surname *
Date of Birth *
Do you have a National Insurance number? YesNo
National Insurance Number *
Address *
Town *
County *
Postcode *
Mobile Phone *
Home Telephone
E-mail Address*
Confirm Email Address*
Password*
Confirm Password*
Nationality *
Gender * —Please choose an option—MaleFemaleNon-BinaryGender Not ListedPrefer not to stateN/a
(this information is confidential and will not be disclosed)
Ethnic Origin * —Please choose an option—Asian - OtherBangladeshiBlack - AfricanBlack - CaribbeanBlack - OtherChineseIndianMixed - White & AsianMixed - White & Black AfricanMixed - White & Black CaribbeanPakistaniWhite - BritishWhite - IrishWhite - Other
Specific Learning Difficulties * DyslexiaDyspraxiaDyscalculiaDysgraphiaAttention Deficit DisorderAttention Deficit Hyperactivity DisorderNone Of The Above
Other non-specific difficulty * MemoryOrganisationalWritingVisual ProcessingReadingAuditoryTime ManagementSensory DistractionSensory OverloadOtherNone Of The Above
Cognitive Learning Difficulties * Verbal MemoryLiteracyWorking Memory / NumeracyProcessing SpeedNon-Verbal MemoryVerbal ReasoningExecutive FunctionVisual Perception / ReasoningNone Of The Above
Other Disabilities * Acquired Brain InjuryAnxiety Disorders and StressAutism Spectrum DisorderBipolar DisorderCancerChronic PainDementiaDepressionDiabetesEpilepsyHearing ImpairmentLimb LossMental HealthMigraineMultiple SclerosisMusculoskeletal DisordersSchizophreniaVisual ImpairmentNone Of The Above
Are you in or have you recently left care? *YesNo
Are you a young carer? *YesNo
Do you need help leaving a building in an emergency? *YesNo
Do you have an Education, Health and Care Plan? * YesNo
Are you happy to share a copy of your Education, Health and Care Plan? *YesNo
Do you have any unspent criminal convictions? *YesNo
Declaration of Criminal Convictions- Our aim is to create a safe and healthy environment for all those who use Skillnet services. This includes all those studying and working at Skillnet or using its services. We have a duty of care to those under the age of 18 and those deemed to be vulnerable and ‘at risk’. To help achieve these goals we need to know about those applying to Skillnet with unspent convictions. If you answer YES, you will be asked to complete a confidential form disclosing the nature of the unspent conviction. A judgment will then be made based on the information provided. Failure to reveal a conviction may end any training agreement with Skillnet. However, having a criminal record will not necessarily bar you from a place on a Skillnet programme. This will depend on the course, circumstances, and background of the offence.
(Must be completed for all learners)
Name *
Relationship to you *
Home Tel. No
Mobile *
Email *
(To be completed if different from Next of Kin and learner is 16-18 years old)
Name
Relationship
Address
County
Postcode
Mobile
Email
For further information refer to Apprenticeship funding rules August 2020 to July 2021
Have you completed school year 11 at the end of the academic year (last Friday in the month of June) and do not intend to return to full time education after the summer holidays?YesNo
Are you enrolled on another apprenticeship or attending school or FE College / university as a full time as a student?YesNo
Are you of British or EEA nationality?YesNo
Are you an overseas national subject to employment or training restrictions and/or full limit on your stay? (Other than a refugee or an asylum seeker).YesNo
Have you been normally and lawfully resident in the UK / EEA for the three years before your apprenticeship start date?YesNo
In which Country have you normally lived over the past three years? *
Are you taking part in any other employment training or enterprise programme or scheme funded by Her Majesty’s Government?YesNo
Are you in custody as a prisoner or on remand in custody?YesNo
Do you have a contract of employment?YesNo
If no will you have contract of employment by your Apprenticeship start date?YesNo
Are you or will you be paid at least the minimum apprenticeship wage?YesNo
Have you already achieved any of the following qualifications? Please select the current level of your highest qualification. None - No qualificationsEntry Level - Literacy/NumeracyLevel 1 - D-G (3-1) or fewer than 5 GCSE’s A-C (9-4) or BTEC 1st Cert or NVQ 1 or Foundation GNVQ or OCR level 1Level 2 - 5 or more GCSE’s A-C (9-4) or fewer than 2 A Levels or BTEC 1st Diploma or NVQ 2 or Intermediate GNVQ or OCR level 2Level 3 - 4 or more AS Levels or 2 A Levels or BTEC National or NVQ 3 or Access to HE or OCR level 3Level 4 or above
If level 4 or above, please indicate Level and Qualification
Level
Qualification
Length of Employment
Weekly Hours Worked
Length of Unemployment
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