Work Experience Application Form
1. Personal Details
Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Home Address
*
Street Address
Street Address Line 2
Town
County
Post Code
Date of Birth
*
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Day
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Month
Year
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2. Occupational Status
What is your current occupational status? (Please tick)
*
Attending School (11 - 16)
Attending Sixth Form/College (16/18)
Attending a Higher Education Institution (Student 18+)
Graduate Job Seeker
Other
If you selected other (please specify)
3. School / Institution Details
School / Institution Name:
*
School Year / Year of Study
*
Course Studied:
*
Date Attended From:
*
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Day
-
Month
Year
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Date Attended to:
-
Day
-
Month
Year
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Email Address of Teacher / Tutor
example@example.com
Phone Number of Teacher / Tutor
Please enter a valid phone number.
4. Placement Request
We believe that placing students in a department in which they have a particular passion is key to maximising the benefit of work experience placements. Therefore, we encourage all applicants to provide as much information as possible to demonstrate their suitability and enthusiasm for working with a particular team.
Which Team would you like to work with?
*
Please specify dates that you are available: From
*
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Day
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Month
Year
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Please specify the dates that you are available: To
*
-
Day
-
Month
Year
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How will your study or experience to date assist you during your placement with this team?
*
How will working with this team help you to follow your desired career path?
*
Please provide any further details that may further support your application.
*
We welcome Applications from all areas of the community. Are there any requirements that we would need to be aware of in order for you to attend a placement at SHBC?
*
5. Declaration
I confirm that the information that I have provided on this Application Form is accurate
*
I confirm
Today's Date
*
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Day
-
Month
Year
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Privacy Statement
Details of Surrey Heath Borough Council’s Privacy Notice can be found
here
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