Work experience registration form

First name:

Surname:

Name known as:

Your address:

Daytime telephone number:

Evening telephone number:

Mobile number

Email address:

What is your preferred method of contact?

Phone
Email
Letter
Text Message

Date of birth: A minimum age of 14 yrs required for a work experience placement

Do you live in a Nottingham City Council property?

Yes
No

Main language:

Other languages spoken:

Please give the dates (or month) that you would like your work experience placement to take place:

Please list the top three areas of work that interest you most:

What are your plans for your future career?

Do you have a disability or medical condition?Yes

Yes
No

Do you require any adjustments, or is there anything about your disability or health issue that we need to be aware of? If so please give details:

Next of kin / emergency contact name:

Next of kin / emergency contact telephone number:

Next of kin / emergency email address:

Please state the relationship to you of your next of kin / emergency contact:

If you are under 18 years old, please ask your parent or guardian to complete this section

Name of parent or guardian:

By ticking this box, I confirm that I have read and understand this form and agree to the applicant participating in a work experience programme at Nottingham City Council Housing Services.

Consent for storing submitted data

Yes, I give permission to store and process my data

Privacy Statement

We will use the information provided by you for monitoring and tracking the employment support you receive from Nottingham City Council Housing Services. Information you provide for this specific purpose may be shared with Nottingham Jobs and the Department for Work and Pensions. The basis under which we use personal data for this purpose is consent. View our full privacy policy here.

Privacy policy
Accessibility

Nottingham City Council Housing Services
Registered Office: Loxley House, Station Street, Nottingham, NG2 3NG.
Registered in England and Wales.