Please tick which areas of learning you are interested in:

• Animal Care
• Horse Care
• Customer Service
• Floristry
• Business Admin
• Horticulture
• Veterinary Nursing
• Other

Section 1: Personal Details

First Name(s)

Middle Name(s)

Surname

Address

Post Code

Tel. No

Mob. No

Email

National Insurance No.

DOB

Part A. General Eligibility

(All Applicants must answer these questions)

1. 1.Were you born or do you have citizenship (hold a passport:-) of either the United Kingdom or any other member state of the European Union/Area?

   YesNo

   (EU states = Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, The Netherlands, United Kingdom, Bulgaria Areas = Iceland, Liechtenstein, Norway, Switzerland

2. 2.Do you have proof of permanent UK residency / Indefinite leave to remain (we will need to see proof)

   YesNo

   If yes go to Part B

3. 3.If No have you got exceptional leave to remain?

   YesNo

4. 4.Have you been living in the United Kingdom or any other member state of the European Union for the last three years?

   YesNo

Part B: Programme Suitability

1. 1.Are you currently:

   • In full time education
   • Employed
   • Voluntary (unpaid)
   • Self employed
   • Unemployed

2. 2.Have you accepted a place and intend to return to full-time education in September? (i.e. College or University)

   YesNo

3. 3.Are you a graduate of higher education?

   YesNo

4. 4.Are you currently in any other funded training programme?

   (e.g. New Deal)

   YesNo

   If yes please state:

Part C: Additional Information

(You only need to complete this section if you have answered NO to any questions 3 or 4 in Part A)

1. 1.Has the UK Government granted you refugee status?

   YesNo

   If you have answered YES to question C1, we will require a copy of a home office letter confirming your status. If you have answered NO, then please answer the next question.

2. 2.If you have not been granted refugee status, have you been granted Exceptional Leave to Enter or Remain by the UK Government and have you remained in the UK since you were granted this leave

   YesNo

   If you have answered YES to question C2, we will require a copy of a home office letter confirming your status or ID card that states leave is granted. If you have answered NO, then please answer the next question.

3. 3.Are you on a learning exchange scheme?

   YesNo

   If you have answered YES to question C3, you will need to provide suitable evidence (i.e. a letter from the exchange programme organiser). If you have answered NO, then please answer the next question.

4. 4.Are you an asylum seeker or the child of an asylum seeker in receipt of one of the following benefits?

   YesNo

   • Income based benefits
   • Assistance under the terms of the Immigration and Asylum Act 1999 or the Children Act 1989
   • Voucher assistance from the National Asylum Support Service
   • Assistance under the National Assistance Act 1948

   If you have answered YES to question C4, you will need a copy of a letter from the local Asylum Support team confirming your status.

Section 2: Educational Background:

Name of last school:

Date left:

Please list your qualifications gained at School, College and Further / Higher Education ensure you include any KEY SKILLS examinations you have passed:

You will be required to bring copies of your GCSE/AS or A LEVEL, ADULT LITERACY/NUMERACY OR KEY SKILLS CERTIFICATES (if applicable) to your interview with Badgehurst Training Ltd.

Have you been on any government funded programme not listed above and not completed (e.g. Train to Gain, Apprenticeship, Entry to Employment, Foundation Learning (please list, if none please state 'none')

Section 3: Your current Status

Employers Name and Address (or state "not currently employed"):

How do you/would you travel to work?

Learner's Employment Status (please complete ONE of the following if employed)

I am employed by: and have a Contract of Employment.

I am self-employed (since month/year) and I have registered my self-employment with the HM Revenue and Customs.

I am a volunteer for (organisation name) and receive no payment for the work undertaken other than incurred expenses where payable

What days/hours do you work?

Are you registered with any Connexions/Careers Offices?

YesNo

Please give details of which office and your connexions/careers advisor

Section 4

If not currently employed, this section is for you to suggest relevant work placements local to you, who you would like us to approach on your behalf. Please check beforehand that you are able to travel to the workplace daily, using local transport as necessary

Section 5: About you

(please make sure you fill in all of the following)

1. 1.What are your Hobbies and Interests? Are you a member of any clubs or societies?

2. 2.What are your employment and career progression objectives?

   Please describe your current roles and responsibilities: