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Work Placement Registration Form
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1.
Question 1.
Service Grouping
Required
- Required.
Chief Executives Office
Economy & Skills
Safer Communities
Health & Social Partnership
East Ayrshire Leisure
Ayrshire Roads Alliance
Other
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2.
Question 2.
Service / Section
Required
- Required.
3.
Question 3.
Name of Trainee
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4.
Question 4.
Name of Sponsor
Required
- Required.
*
5.
Question 5.
Trainee Contact Details
Required
- Required.
Home Address
Address
Town / Village
Post Code
Contact Number
Contact Email
*
6.
Question 6.
Emergency Contact Details
Required
- Required.
Name
Relationship to Trainee
Contact Number
Address (if Different from trainee)
*
7.
Question 7.
Proposed Start Date
Required
- Required.
*
*
8.
Question 8.
Proposed End Date
Required
- Required.
*
*
9.
Question 9.
Health & Safety Checklist (It is the responsibility of the Service to ensure that an appropriate Risk Assessment is undertaken and suitable measures; information; equipment provided)
Check Completed by
Required
- Required.
Chamber of Commerce
Skills Development & Employability Service
Placement Sponsor (Trainee must be 16 years or over)
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