The information that you have provided will be handled and processed in accordance with the General Data Protection Regulation (2018). If you start training, this information will form part of your personal record and may be used by the Harington for business purposes. Personal Details First Name * Last Name * Date of Birth * Year Year1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Age on 31st August 2025 * National Insurance Number * Boot size (for safety boots) * Gender * Female Male Address * Postcode * Do you live with parents or carers, partner, in a residential home, alone, or none of these? In which Borough or County is this address? * How long have you lived at this address? Telephone Number * Mobile Number Email Address * Next of kin * Next of kin address * Phone number Email Residency Details What is your nationality? Are you a resident of the UK? * Yes No Have you been a resident for the last three years? Yes No Please give your country of usual residence If born outside of the UK, please give your date of arrival in the UK Year Year1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 What is your current status? * Asylum seeker Refugee Permanent Settlement Student Visa Work Permit Visitors Visa Other Other (Please specify) Are there any restrictions or limitations on your stay in the UK? (Please specify) * Please note that you may have to provide your passport and papers, so that we have evidence of your status. Secondary EducationPlease number all of your entries so we can see which qualifications/grades etc corresponds to which school/dates Name and address of school(s) and dates Please put the name and address of schools attended together with the date you started and the date you left. You only need to put schools attended since the age of 11 Subject/qualification and grades Please enter the name of all your qualifications and the corresponding grades Qualification/subject expected grades Please enter your expected grades with the associated qualifcation/subject Colleges and Training Name and address of college(s) and dates Please put the name and address of colleges attended together with the date you started and the date you left. College subject/qualification and grades Please enter the name of all your qualifications and the corresponding grades College qualification/subject expected grades Please enter your expected grades with the associated qualifcation/subject Employment Employment details Please enter the name and address of your employers, the dates you worked with them and your job title and details of your duties for each employer Are you unemployed * Yes No How long have you been out of work? Less than six months 6 months to 12 months 12 months to 24 months 24 to 35 months More than 36 months Work experience Please tell us about any work experience you have, including work experience or voluntary work that you have done Support and Interests Please give details of any extra support you would need, if you were training at Harington (For example, help with reading and writing, number work, travelling new routes to a work experience placement, time away from your working group to calm down if you become upset or agitated) Do you have an Educational Health care Plan? * Yes No Did you get extra help with anything at school, college or in training? Do you have a disability or health need? Yes No Disability or health needs details What are your hobbies and interests? What careers are you interested in? Why do you want to come to Harington? Health Information Doctor’s name and telephone number Do you have any of these health issues? Epilepsy Asthma Diabetes Allergies Other No health issues Please give details Do you take any tablets or medicine other than over the counter painkillers? Yes No Please give the name and amounts of any medication and when it is taken Would you need any help with this if you were training at Harington? Yes No What help would you need? What is the date of your most recent tetanus vaccination? Year Year1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Background How would you describe your ethnic origin * - Select -EnglishIrishGypsy or Irish TravellerOther White backgroundIndianPakistaniBangladeshiChineseOther Asian backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianOther mixed/multiple ethnic backgroundAfricanCaribbeanOther Black backgroundArabAny other ethnic groupPrefer not to say What is the spoken language at home? State Support Are you entitled to free meals at school or college? Yes No Do you have a Free Travel Pass? Yes No A freedom pass or zip card Do you receive any welfare benefits? Yes No Which benefit do you receive? Disability Living Allowance / Pip Care Mobility Income support allowance Employment Support Allowance Universal Credit Criminal ConvictionsPlease declare any previous convictions. If you have multiple convictions, please number each one. Do you have any previous convictions? * Yes No Charge Penalty Date Do you have any court cases pending? * Yes No Charge Date Declaration * I declare that all of these details are, to the best of my knowledge, true and correct Yes
