Creative Apprenticeships APPLICATION FORM

Please complete all the questions fully. We will allocate interviews based on answers provided – continue on separate sheets if more space is needed. This programme is aimed at young people who have left school/college aged 16-18 or 19+

Return applications to: COLLAGE ARTSLEARNING TEAMChocolate Factory 2

4 Coburg Road, Wood GreenLondon N22 6UJ

Title (Ms/Miss/Mrs/Mr) First Name Surname/Family Name

Date of Birth Age National Insurance No Any Previous Applications

Permanent Home Address:

Postcode: Borough:

Home Tel No:

Mobile Tel No:

E-mail address:

EMPLOYMENT STATUS Are you unemployed? Yes No Which benefits are you

claiming?

If YES how long? For how long?

Name of Adviser (JobCentre Plus or Support Agency):

Name and Address of Local JobCentre Plus/ Support Agency and phone number:

If NO, is your work Full-time/ Part-time or Freelance?

How many hours per week?

Name of Employer/Company:

Address of Employer/Company, phone number & email:

1. Where did you hear about Collage Arts and this course?

All applications will be treated confidentially.

We will contact you by phone or in writing to arrange a suitable interview date. Please make sure you fill in a contact telephone number, address and email.

tel: 020 8829 8900; fax: 020 8365 8686web: www.collage-arts.orgemail: info@collage-arts.org

CURRENT AND PREVIOUS ACTIVITIES

2. Please provide details of past education or training qualifications gained in any field:

Dates Establishment Qualification Course Information

3. Please provide employment details and include any voluntary work (dates, job title and main responsibilities), listing your most recent jobs first:

Dates Company Duties/Activities

4. What do you hope to achieve by completing this programme? (tick as appropriate)

Improvement in Creative Skills Higher Courses, eg, University

Work Experience Full or Part-time job

Networks/Contacts in the field Self-employment (set up own business)

Other (please specify) _____________________________________________________________

5. Do you have any learning difficulty and/or disability for which you require assistance for access, equipment or special help?

Yes No

Learning Difficulty, Disability or Health Condition Requirements (continue on a separate sheet if necessary)

6. This course operates in an environment which positively challenges racism, sexism, homophobia (ie, anti-gay/lesbian) and any other type of discrimination.

How would you find working and studying in this environment?

7. What other interests/hobbies do you have?

LEARNING/C.Apps.appln-v1.08.11 2

I DECLARE THAT THE INFORMATION GIVEN ON THIS FORM IS TRUE AND ACCURATE.

Signature: _________________________________ Date: _____________________

Name: _________________________________

THANK YOU FOR COMPLETING THE APPLICATION FORM.

COMPLETE THE EQUAL OPPORTUNITIES TRACKING FORM ON PAGE 4 AND RETURN BOTH FORMS TO:

COLLAGE ARTSLEARNING TEAMChocolate Factory 2

4 Coburg Road, Wood GreenLondon N22 6UJ

or email application to: nathan@collage-arts.org

EQUAL OPPORTUNITIES STATEMENT:Collage Arts is fully committed to eliminating all forms of discrimination, whether based on race, gender, sexuality, marital status, disabilities, age, religious belief, or status in organisation.

DATA PROTECTION STATEMENT: The information on this form will be stored in a computerised database. The information will be used for statistical purposes only, and personal data will not be revealed to any organisations other than those declared to the Data Protection Registrar. Collage Arts is committed to implementing and complying with the Data Protection Principles of good computer practice.

LEARNING/C.Apps.appln-v1.08.11 3

12 – Black or Black British – Caribbean □13 – Black or Black British – African □14 – Black or Black British – Other □15 – Other (Specify) □

a - Afghani □b - Brazilian □c - Chilean □d - Columbian □e - Croatian □f - Czech □g - Greek □h - Greek Cypriot □i - Iranian □j - Iraqi □k - Kosovan □l - Kurdish □m - Mexican □n - Polish □o - Russian □p - Serbian □q - Turkish □r - Turkish Cypriot □

16 – Prefer not to say □

CONFIDENTIALEqual Opportunities Tracking Form

Please complete this form in order to allow us to monitor the effectiveness of our Equal Opportunities Policy. All the information given will be treated in the strictest confidence.

Full Name: Date:

Gender: Age:Male □ <16 □Female □ 16-18 □

19-24 □25-49 □50+ □

Priority Groups:Registered disabled □Health Issues/Learning disabilities/ other disabilities (not registered) □Refugee / Asylum Seeker □Unemployed □Lone Parent □Ex-offender □Homeless Person □

LEARNING/C.Apps.appln-v1.08.11 4

Ethnic Origin:1 – White – British/UK □2 – White – Irish □3 – White – Other (Specify) □

a – French □b – Italian □c – Spanish □d - ________________________

4 – Mixed – White and Black Caribbean □5 – Mixed – White and Black African □6 - Mixed – White and Asian □7 – Mixed – Other ( Specify) e - ________________________8 – Asian or Asian British – Indian □9 – Asian or Asian British – Pakistani □10 – Asian or Asian British – Bangladeshi □11 – Asian or Asian British – Other (specify)

a – Chinese □b – Japanese □c – Sri Lankan □d – Vietnamese □e - _________________________