Change of Employer Submission

Apprenticeship Change of Employer Form

SECTION A - Apprentice / Programme Details

Apprentice First Name:

Apprentice Date of Birth:

Apprentice Surname:

Apprentice Job Title:

Current Apprenticeship Employer:

Start date of Apprenticeship programme:

Planned end date of Apprenticeship:

SECTION B - New Apprenticeship Employer Details

New Apprenticeship Employer:

Postcode:

Number of employees at this location:

Start date:

Planned end date:

Levy Status:

Main Contact Full Name:

Main Contact Job Title:

Main Contact Telephone Number:

Main Contact Email Address

Workplace Mentor Full Name

Workplace Mentor Job Title:

Workplace Mentor Contact Number:

Workplace Mentor Email Address:

SECTION C - Payment

Outstanding Fee (£) (Including Training and End Point Assessment):

Contribution Requirement:

0% - Employer is Non Levy with fewer than 50 employees and the apprentice is aged 16-18

5% - Employer is Non-Levy and apprentice originally started after 01/04/2019

10% - Employer is Non-Levy and apprentice originally started before 01/04/2019

100% - Employer is a Levy paying organisation

Fee to be paid by new Employer (£) (Excluding VAT):

How would the employer like to make payment:

Digital Apprenticeship Service (Levy only)

One off payment (Cash)

One off payment (Card)

Instalments (Direct Debit)

Other

SECTION D - Employment Hours / Off the Job Training (OTJT) (Minimum 20%)

How many hours per week will the apprentice be employed for:

How many hours will be reserved for OTJT:

SECTION E - Additional Documents / Declarations

Tutor / Assessor Declaration

By signing I confirm that to the best of my knowledge the details contained within this form and true and accurate. In addition to this form I will send all necessary Health and Safety (2A /3A) paperwork to the ATL Health and Safety Manager.

Tutor/Assessor Name:

Tutor/Assessor Signature:

Sign Here

Employer Declaration

By signing I confirm that to the best of my knowledge the details contained within this form and true and accurate. I understand that the change requested and agreed between myself and the Training Provider will apply an amendment to the previously agreed Training Plan.

Employer Name:

I confirm that I have read and agree to the apprentice's original Training Plan

I confirm that I have read and agree to the ATL Contract of Services

Employer Signature:

Sign Here

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