Traineeship Enrolment Form16-18 Traineeship Enrolment Form To undertake a Traineeship Programme, you must ensure that you meet the individual and funding eligibility requirements:You must meet any course specific entry requirementsYou must not hold a Level 4 or above qualification (or equivalent)You must be unemployed or have little or no work experienceYou must be a UK/EU citizen or have the legal right to be in the UKHave been a resident of the UK for the 3 years preceding the course start dateYou must be aged 16 - 18 on the 31.08.2022You must be assessed as having the potential to be ready for employment within 12 monthsProgramme DetailsPlease provide the start date for this Traineeship:Please select the Employability Qualification Level that will be undertaken:- Select -Entry 3Level 1Level 2Please select the Mathematics Qualification that will be undertaken:- Select -60349165 Entry 2 Functional Skills Qualification in Mathematics60349177 Entry 3 Functional Skills Qualification in Mathematics60346486 Level 1 Functional Skills Qualification in Mathematics60346498 Level 2 Functional Skills Qualification in MathematicsNot Applicable - Learner ExemptPlease upload evidence of the prior attainment for Math exemption:Choose File Please select the responsible Mathematics Tutor:- Select -Dave HatherallJane SedgemoreRobert MillerSue ColePlease select the English Qualification that will be undertaken:- Select -60349141 Entry 2 Functional Skills Qualification in English60349153 Entry 3 Functional Skills Qualification in English60346462 Level 1 Functional Skills Qualification in English60346474 Level 2 Functional Skills Qualification in EnglishNot Applicable - Learner ExemptPlease upload evidence of the prior attainment for English exemption:Choose File Please select the responsible English Tutor:- Select -Clare AhmadiJonothon Paul JonesMark CoombsWIll the learner be undertaking any additional qualifications?- Select -YesNoPlease select the additional qualification the learner will be enrolling on:- Select -HS1B - 60012973 Level 1 Certificate in Introduction to Health, Social Care and Children's and Young People's SettingsHS1C - 60012973 Level 1 Certificate in Introduction to Health, Social Care and Children's and Young People's SettingsHS2A - 60000776 Level 2 Certificate in Preparing to Work in Adult Social CareHS2B - 60000776 Level 2 Certificate in Preparing to Work in Adult Social CareHS2C - 60000776 Level 2 Certificate in Preparing to Work in Adult Social CareITE3 - 50106387 Entry 3 Functional Skills ICTITL1 - 50096308 Level 1 Functional Skills ICTNL2B - 50086844 Level 2 Award in Nail Technology (January Cohort)NL2C - 50086844 Level 2 Award in Nail Technology (April Cohort)MU2A - 50098457 Level 2 Certificate in Make Up (January Cohort)MU2B - 50098457 Level 2 Certificate in Make Up (April Cohort)WORK PLACEMENT AND WORK PREPARATION TRAININGWork Placement QAN Code = ZWRKX001 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 160 Tutor/Assessor: Rita Melville Attendance: Friday (09:00 - 17:00) Entry 3 Award in Employability Skills QAN Code = 60146783 Duration: 18 Weeks Start Week: Week 1 Planned Hours: 36 Hours Tutor/Assessor: Jill Williams Attendance: Wednesday (13:00 - 15:00) Room: NU1.OPENWORK PLACEMENT AND WORK PREPARATION TRAININGWork Placement QAN Code = ZWRKX001 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 160 Tutor/Assessor: Rita Melville Attendance: Friday (09:00 - 17:00) Level 1 Award in Employability Skills QAN Code = 60146801 Duration: 18 Weeks Start Week: Week 1 Planned Hours: 36 Hours Tutor/Assessor: Jill Williams Attendance: Wednesday (13:00 - 15:00) Room: NU1.OPENWORK PLACEMENT AND WORK PREPARATION TRAININGWork Placement QAN Code = ZWRKX001 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 160 Tutor/Assessor: Rita Melville Attendance: Friday (09:00 - 17:00) Level 2 Award in Employability Skills QAN Code = 60146643 Duration: 18 Weeks Start Week: Week 1 Planned Hours: 36 Hours Tutor/Assessor: Jill Williams Attendance: Wednesday (13:00 - 15:00) Room: NU1.OPEN MATHEMATICS ELEMENTEntry 2 Functional Skills Mathematics QAN Code = 60349165 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Dave Hatherall Attendance: Thursday (13:00 - 15:00) Room: NU1.OPEN MATHEMATICS ELEMENTEntry 2 Functional Skills Mathematics QAN Code = 60349165 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jane Sedgemore Attendance: Thursday (13:00 - 15:00) Room: NU1.OPEN MATHEMATICS ELEMENTEntry 2 Functional Skills Mathematics QAN Code = 60349165 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Sue Cole Attendance: Thursday (13:00 - 15:00) Room: NU1.OPEN MATHEMATICS ELEMENTEntry 3 Functional Skills Mathematics QAN Code = 60349177 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Dave Hatherall Attendance: Thursday (13:00 - 15:00) Room: NU1.OPEN MATHEMATICS ELEMENTEntry 3 Functional Skills Mathematics QAN Code = 60349177 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jane Sedgemore Attendance: Thursday (13:00 - 15:00) Room: NU1.OPEN MATHEMATICS ELEMENTEntry 3 Functional Skills Mathematics QAN Code = 60349177 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Sue Cole Attendance: Thursday (13:00 - 15:00) Room: NU1.OPEN MATHEMATICS ELEMENTLevel 1 Functional Skills Mathematics QAN Code = 60346486 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Dave Hatherall Attendance: Thursday (13:00 - 15:00) Room: NU1.OPENMATHEMATICS ELEMENTLevel 1 Functional Skills Mathematics QAN Code = 60346486 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jane Sedgemore Attendance: Thursday (13:00 - 15:00) Room: NU1.OPENMATHEMATICS ELEMENTLevel 1 Functional Skills Mathematics QAN Code = 60346486 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Sue Cole Attendance: Thursday (13:00 - 15:00) Room: NU1.OPENMATHEMATICS ELEMENTLevel 2 Functional Skills Mathematics QAN Code = 60346498 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Dave Hatherall Attendance: Thursday (13:00 - 15:00) Room: NU1.OPENMATHEMATICS ELEMENTLevel 2 Functional Skills Mathematics QAN Code = 60346498 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jane Sedgemore Attendance: Thursday (13:00 - 15:00) Room: NU1.OPENMATHEMATICS ELEMENTLevel 2 Functional Skills Mathematics QAN Code = 60346498 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Sue Cole Attendance: Thursday (13:00 - 15:00) Room: NU1.OPENENGLISH ELEMENTEntry 2 Functional Skills English QAN Code = 60349141 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Mark Coombs Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENENGLISH ELEMENTEntry 2 Functional Skills English QAN Code = 60349141 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jonothon Paul Jones Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENENGLISH ELEMENTEntry 3 Functional Skills English QAN Code = 60349153 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jonothon Paul Jones Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENENGLISH ELEMENTEntry 3 Functional Skills English QAN Code = 60349153 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Mark Coombs Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENENGLISH ELEMENTLevel 1 Functional Skills English QAN Code = 60346462 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Mark Coombs Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENENGLISH ELEMENTLevel 1 Functional Skills English QAN Code = 60346462 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jonothon Paul Jones Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENENGLISH ELEMENTLevel 2 Functional Skills English QAN Code = 60346474 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Jonothon Paul Jones Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENENGLISH ELEMENTLevel 2 Functional Skills English QAN Code = 60346474 Duration: 20 Weeks Start Week: Week 1 Planned Hours: 30 Tutor/Assessor: Mark Coombes Attendance: Thursday (10:00 - 12:00) Room: NU1.OPENFLEXIBLE ELEMENTQualification: 500/8684/4 Level 2 Award in Nail Technology Start Date: 12/01/2023 Planned end Date: 09/03/2023 Planned Learning Hours: 48 Room: NU4.NAIL Attendance Day(s): Thursday Tutor: Claire LambertFLEXIBLE ELEMENTQualification: 500/9630/8 Level 1 Functional Skills Qualification in ICT Duration: 8 Weeks Start Week: Week 1 Planned Learning Hours: 12 Room: NU1.2 Attendance Day(s): Wednesday (3pm - 4:30pm) Tutor: Shaun LeaverFLEXIBLE ELEMENTQualification: 501/0638/7 Entry 3 Functional Skills Qualification in ICT Duration: 8 Weeks Start Week: Week 1 Planned Learning Hours: 12 Room: NU1.2 Attendance Day(s): Wednesday (3pm - 4:30pm) Tutor: Shaun LeaverFLEXIBLE ELEMENTQualification: 500/8684/4 Level 2 Award in Nail Technology Start Date: 20/04/2023 Planned end Date: 22/06/2023 Planned Learning Hours: 48 Room: NU4.NAIL Attendance Day(s): Thursday Tutor: Claire LambertFLEXIBLE ELEMENTQualification: 600/1297/3 - Level 1 Certificate in Introduction to Health, Social Care and Children's and Young People's Settings Start Date: 16/01/2023 Planned end Date: 21/02/2023 Planned Learning Hours: 72 Room: NU2.7 Attendance Day(s): Monday / Tuesday Tutor: Rebecca BacheFLEXIBLE ELEMENTQualification: 600/1297/3 - Level 1 Certificate in Introduction to Health, Social Care and Children's and Young People's Settings Start Date: 17/04/2023 Planned end Date: 30/05/2023 Planned Learning Hours: 72 Room: NU2.7 Attendance Day(s): Monday / Tuesday Tutor: Rebecca BacheFLEXIBLE ELEMENTQualification: 600/0077/6 Level 2 Certificate in Preparing to Work in Adult Social Care Start Date: 21/10/2022 Planned end Date: 13/01/2023 Planned Learning Hours: 66 Room: NU2.7 Attendance Day(s): Friday Tutor: Georgina HolidayFLEXIBLE ELEMENTQualification: 600/0077/6 Level 2 Certificate in Preparing to Work in Adult Social Care Start Date: 03/03/2023 Planned end Date: 19/05/2023 Planned Learning Hours: 66 Room: NU2.7 Attendance Day(s): Friday Tutor: Georgina HolidayFLEXIBLE ELEMENTQualification: 600/0077/6 Level 2 Certificate in Preparing to Work in Adult Social Care Start Date: 23/06/2023 Planned end Date: 01/09/2023 Planned Learning Hours: 66 Room: NU2.7 Attendance Day(s): Friday Tutor: Georgina HolidayFLEXIBLE ELEMENTQualification: 500/9845/7 Level 2 Certificate in Make Up Start Date: 05/01/2023 Planned end Date: 30/03/2023 Planned Learning Hours: 48 Room: NU3.SALON3 Attendance Day(s): Thursday Tutor: Beccy YoungFLEXIBLE ELEMENTQualification: 500/9845/7 Level 2 Certificate in Make Up Start Date: 20/04/2023 Planned end Date: 13/07/2023 Planned Learning Hours: 48 Room: NU3.SALON3 Attendance Day(s): Thursday Tutor: Beccy YoungPreviousNextLearner Personal DetailsPlease enter your legal FIRST NAME: Please enter your legal SURNAME:Sex:- Select -MaleFemaleGender:- Select -MaleFemaleIntersexNon-binaryTransexualTransgenderTransTrans ManTrans WomanTransitioningQuestioningOtherPrefer not to sayTitle- Select -MrMrsMissMsDrRevHonMxOtherSexual Orientation:- Select -StraightGay / LesbianBisexualPansexualAromanticAsexualQuestioningOtherPrefer not to sayEmailPlease enter any previous surnames you have:Date of BirthNational Insurance NumberFirst line of your address: PostcodeNumber of years you have lived at this address: - Select -Less than 11234 or moreNumber of years you have been a resident in the UK:- Select -Less than 11234 or moreLandline telephone number:Mobile telephone number: Household situation- Select -03: I live in a single adult household with dependants01: I live in a household where no members are in employment and there are dependants02: I live in a household where no member are in employment and there are no dependants98: I would like to withhold this information99: None applyEthnicity- Select -31: White British32: Irish33: Gypsy/Irish Traveller34: Any Other White Background35: White & Black Caribbean36: White & Black African37: White & Asian38: Any Other Mixed / multiple ethnic background39: Indian40: Pakistani41: Bangladeshi42: Chinese43: Any other Asian background44: African45: Caribbean46: Any other Black / African / Caribbean background47: Arab98: Any other ethnic group99: Prefer not to sayNationality- Select -EnglishNorthern IrishScottishWelshOtherDo you have any of the following learning difficulties / disabilities ? Visual impairment Hearing impairment Disability affecting mobility Profound complex disabilities Social and Emotional difficulties Mental health difficulty Moderate learning difficulty Severe learning difficulty Dyslexia Dyscalculia Autism spectrum disorder Asperger's Syndrome Temporary disability after illness Speech, Language and Communication needs Other physical disability Other specific learning difficulty (e.g. Dyspraxia) Other medical condition (for example epilepsy, asthma, diabetes) Other learning difficulty Other disability Prefer not to say NoneHave you ever held an EHCP (Educational health care plan) or 139a / statement? Yes NoWould you like the Learner Support Manager to contact you to discuss any queries you may have?- Select -Yes (by phone)Yes (by email)NoPreviousNextPrevious qualifications / ExperiencePlease detail any qualifications you have previously attained.Relating to the qualifications you have previously attained please select the most appropriate below:- Select -99: No Prior Qualifications09: Entry Level Qualifications01: Level 1 Qualifications02: Full Level 2 Qualifications (Eg. 5 or more GCSE's)03: Full Level 3 Qualifications (Eg. 2 or more A Levels)10: Level 4 Qualifications (Eg. Certificate of Higher Education)11: Level 5 Qualifications (Eg. Foundation Degree)12: Level 6 Qualifications (Eg. Bachelors Degree)13: Level 7 or above Qualifications (Eg. Doctorate / Masters Degree)Please enter your highest GCSE Maths grade:- Select -AA*A*AAAABBBBBCCCCCDDDDDEEEEEFFFFFGGGGU123456789NonePlease enter your highest GCSE English grade: - Select -AA*A*AAAABBBBBCCCCCDDDDDEEEEEFFFFFGGGGU123456789NonePlease tell us about any previous experience you have that is relevant to your chosen course:Please tell us how this course is relevant to your career objectives:PreviousNextEmployment DetailsWhich of the following best describes your employment status: *- Select -10: Employed Part Time10: Employed Full Time10: Self Employed Part Time10: Self Employed Full Time11: Unemployed and looking for work12: Unemployed and not looking for workEmployed Individuals (Further details)Please only complete this section if you have stated in the previous question that you are employedHow long have you been employed:- Select -Employed for 0-3 MonthsEmployed for 4-6 MonthsEmployed for 7-12 MonthsEmployed for 12+ MonthsIs your salary less than £17,004.00 (before deductions)? Yes NoLow salary evidence – please upload evidence of your last 3 months payslips:Choose File How many hours do you work per week:- Select -0 - 10 Hours11 - 20 Hours21 - 30 Hours31+ HoursEmployer NameEmployer PostcodeUnemployed Individuals (Further details)Please only complete this section if you have stated in the previous question that you are unemployedHow long have you been unemployed:- Select -Unemployed for 0-6 MonthsUnemployed for 7-11 MonthsUnemployed for 12-23 MonthsUnemployed for 24-35 MonthsUnemployed for 36+ MonthsAre you in receipt of any government benefits? Yes NoPlease state the benefits you are currently in receipt of: Job Seekers Allowance Employment & Support Allowance Another state benefit other than JSA or ESA Universal Credit NonePlease upload evidence of the benefits you are in receipt of:Choose File PreviousNextNext of Kin detailsNext of Kin name: Next of Kin relationship:Next of Kin telephone numberNext of Kin email address:PreviousNextContact PreferencesThe European Social Fund (ESF) Managing Authority (or agents acting on it's behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training.Your personal information is used by the DfE to exercise its functions and to meet its statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009 and to create and maintain a unique learner number (ULN) and a personal learning record (PLR). Your information will be securely destroyed after it is no longer required for these purposes. Your information may be shared with third parties for education, training, employment and well-being related purposes, including for research. This will only take place where the law allows it and the sharing is in compliance with the data protection legislation. You can agree to be contacted for other purposes by selecting one of the below:- Select -4: I do not wish to be contacted6: I agree to be contacted by the DfE about courses or learning opportunities7: I agree to be contacted by the DfE about surveys and research67: I agree to be contacted by the DfE about courses; learning opportunities; surveys and researchI consent to Achievement Training Limited, CSW Group and City College Plymouth processing my personal data under Data Protection legislation in accordance with Article 6 with my consent and to process my information and understand that this is for the performance of the contract in relation to the course that I have applied for, I acknowledge that specific details of processing activities undertaken by ATL and City College Plymouth is available on the Achievement Training Limited website. By submitting this form I agree to Achievement Training processing the personal data on this form in accordance with prevailing Data Protection legislation. You can agree to be contacted by Achievement Training for other purposes by ticking any of the following boxes:- Select -By PostBy TelephoneBy EmailLRS (Learning Records Service) - The information you supply will be used by the Education and Skills Funding Agency, an Executive Agency of the Department for Business, Innovation and Skills, to issue you with a ULN (Unique Learner Number), and to create your personal learning record. For more information about how your information is processed and shared refer to the Extended Privacy Notice available on Gov.uk (The LRS privacy notice is available to view here: https://bit.ly/2xQNzk8), you cannot opt out, you can however opt-in to sharing your participation and achievement data through the Learning Records Service by ticking below: Opt-in to share personal learning recordLearner Signature Sign HerePreviousNextEnrolling Officer DeclarationType of identification provided by the learner:- Select -PassportDriving LicenceBirth CertificateBank Card / StatementUtility BillNational ID Card / ASPENNational Insurance CardResidence PermitOtherPlease confirm you have checked learner ID held with the enrolment form: I have witnessed the learner and confirm that they are a true likeness to the identification provided. The name is correct and recorded correctky on the enrolment form.Please confirm you have checked the details entered on the enrolment form: I confirm that I have reviewed the enrolment form and confirm that all details including the learner address and contact details are correct.Where a customer has stated they are unemployed and in receipt of state benefits, please state which benefit you have witnessed and can confirm the customer is in receipt of:- Select -Universal CreditJob Seekers AllowanceIncome SupportWorking Tax Credits / Child Tax CreditsEmployment and Support AllowanceCarers AllowanceOtherN/A - Learner not in receipt of benefitsPlease upload evidence of the Maths BKSB assessment showing the level achieved:Choose File Please upload evidence of the English BKSB assessment showing the level achieved:Choose File Please note: If the learner is enrolling on a functional skills qualification, the relevant Diagnostic Assessment must be available. I confirm to the best of my knowledge the information supplied by the learner is correct I have determined the learners eligibility for the chosen programme. I have discussed and agreed a programme with the learner including level, course content and attendance requirements, start dates and planned end dates.Enrolling Officer Signature: Sign HereDate / TimePreviousSubmit Form