Remote Change of Employer FormApprenticeship Change of Employer Form SECTION A - Apprentice / Programme DetailsApprentice 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 DetailsNew Apprenticeship Employer:Postcode:Number of employees at this location:Start date:Planned end date:Levy Status:- Select -LevyNon-LevyMain Contact Full Name:Main Contact Job Title:Main Contact Telephone Number:Main Contact Email AddressWorkplace Mentor Full NameWorkplace Mentor Job Title:Workplace Mentor Contact Number:Workplace Mentor Email Address:SECTION C - PaymentOutstanding 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 organisationFee 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) OtherSECTION 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:Please state what days OTJT delivery will take place: Monday Tuesday Wednesday Thursday Friday Saturday SundayPlease state the times in which delivery will take place: 07:00 - 08:00 08:00 - 09:00 09:00 - 10:00 10:00 - 11:00 11:00 - 12:00 12:00 - 13:00 13:00 - 14:00 14:00 - 15:00 15:00 - 16:00 16:00 - 17:00 17:00 - 18:00 18:00 - 19:00 19:00 - 20:00Please state where delivery will take place: Employer Location Achievement Training Limited Direct Training 2 Care Limited ATN Training & Consultancy Limited Apprentice Home Location OtherSECTION E - Additional Documents / DeclarationsTutor / Assessor DeclarationI 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:Employer DeclarationBy 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 Commitment Statement.Employer Name: I confirm that I have read and agree to the apprentice's original Commitment Statement I confirm that I have read and agree to the ATL Contract of ServicesEmployer Signature: Sign Here Submit Form