• Mon - Thurs 8.30 - 4.30 Fri  8.30 - 3.30
  • Kensington 302-304 Kensington,
  •  0151 259 1556

Application form

Rocket Training

APPLICATION FORM


The Information you supply on this form will be treated in confidence


SECTION ONE PERSONAL DETAILS
Telephone


Social Worker


Care Workerr


GenderMaleFemale
How did you hear about us :FacebookConnectionsFriendWebsiteTwitterOther
Do you have access to a computer/TabletYesNo

SECTION TWO QUALIFICATIONS

Qualifications

Grade

Date achieved

Additional Qualifications

Qualifications Work related

Grade

Date achieved

SECTION 3 WORKING ACTIVITIES/EXPERIENCE (please include any work
experience and/or voluntary work)

Name and Address of Employer:

Dates from and to:

Position

Duties




SECTION 4 PERSONAL DETAILS

Do you have any health issues which might affect your
learning? YesNo

Do you have and additional needs which could affect your
learning? YesNo

Are you involved with any agencies who are supporting your
access to learning?YesNo

For individuals
under 25 only:

Have you had an Education and Health Care PlanYesNo


Are you a Care LeaverYesNo


Are you living independentlyYesNo


Household Situation (please tick the statement which describes
you the best):

No member of the household in which I live (including myself) is employed

The household that I live in includes only one adult (age 18 or over)

There are one or more dependent children (aged 0-17 years or 18-24 years if full time student or inactive) in the household

None of these statements apply

I confirm that I wish to withhold this information

SECTION 5 EQUALITY AND DIVERSITY MONITORING

Ethnic Group

A. WHITE White UKIrishWhite non UKAny other white
B. MIXED White & Black CaribbeanWhite & Black AfricanWhite & AsianAny other mixed background
C. ASIAN OR ASIAN BRITISH IndianPakistaniBangladeshiAny other Asian
D. BLACK OR BLACK BRITISHBlack CaribbeanBlack AfricanAny other Black background


E. CHINESE OR OTHER ETHNIC GROUPChineseVietnameseAny other
F. I DO NOT WISH TO PROVIDE INFORMATION

CONFIRMATION OF ELIGIBILITY

To benefit from government funding to support your learning programme Rocket Training needs you to confirm your eligibility. Please tick the
boxes below which apply to you.

Confirm that you have completed year 11 and are older than the legal school leaving age.

Confirm that you are not attending any other course including Higher Education.

Confirm that you are a citizen of the European Economic area.

Confirm that you have the right to work in England.

Confirm that you have status to live in the UK if you are a refugee and/or asylum seeker.




I confirm that the information above is correct.


If the Applicant is under the age of 16, a Parent / Guardian must sign to give consent for the applicants data to be processed.

We may collect additional reports and information to verify information supplied on this application and to support your application, where the law allows it .