Step 1 of 9 11% MAIN PROVIDER: Umbrella TrainingA: APPRENTICE DETAILSName First Name(s) Surname (Family Name) Apprenticeships or industries applied for(e.g. manager, team member, if unsure type “any”)Home Address Address Line 1 Address Line 2 Town / City County Home Postcode Telephone No.Mobile No.Time at Address (Years)Email Address Date of Birth Date Format: DD slash MM slash YYYY SexMaleFemaleCurrent AgeCountry of BirthNational Insurance NumberUnique learner Number (ULN) (if known) Save and Continue Later B: EMPLOYMENT INFORMATIONThis section informs your suitability for an Apprenticeship – fill in the relevant section if you are employed, currently unemployed or self employedEmployment Status I am employed under a contract of employment or zero hours contract (Emp Status on ILR code 10) I am self employed I am Unemployed How many hours are you contracted for?What is your job title?What date did you start your employment? Date Format: DD slash MM slash YYYY How long have you performed your current job role in your career?How many hours a week are you employed?Is this 0-10 hours per week?Is this 11-20 hours per week?Is this 21-30 hours per week?Is this 31 hours or more per week?Is this a zero hours contract?How long have you been employed?Up to 3 months4 to 6 months7 to 12 monthsMore than 12 monthsEmployer NameEmployer Telephone No.Employer Address Address Line 1 Address Line 2 Town / City County Postcode Manager/Supervisor Name and their title(please ask their permission) Name Position If Unemployed, are you...looking for work and available to start immediately (ILR code 11)Not looking for work and / or not able to start (including if still at school) (12)How long have you been unemployed?Less than 6 months6-11 months12-23 months24-35 monthsOver 36 monthsAre you currently in receipt of any government benefits? Job Seekers Allowance (JSA) Employment & Support Allowance (ESA WRAG) Universal Credit Any Other Save and Continue Later C: PRIOR QUALIFICATIONSthis section will inform the learning aims that we will deliver within the Apprenticeship Please list your qualifications (e.g. GCSEs, A Levels, GNVQs, NVQs) gained at School, College and Further / Higher Education.Maths & English Qualifications (Insert Grade / Level & Year of Achievement)English Language GCSEEnglish Literature GCSEMathematics GCSEFunctional Skills EnglishFunctional Skills MathematicsFunctional Skill in ICTICT GCSEIf results are provisional tick below Yes, my results are provisional Other Qualifications (GCSE, A Level, GNVQ, NVQ, Degree)Please tick the box which is your highest level of prior qualificationEntry Level Entry Level QCF Award at Entry level ; QCF Certificate at Entry level; Certificate in Adult Literacy, Numeracy, ESOL at Entry level; RQF qualifications at Entry Level; English and Maths Stepping Stones qualifications at Entry Level; Entry Level 1,2 or 3 Functional Skills (Code 7/9)Level 1 Level 1 GCSE/O Level (at grades D-G or fewer than 5 at grades A-C) GCSE (9-1) (less than 5 at grade 4 or above); CSE below grade 1; 1 AS Level (for AS qualifications regulated before 1 September 2015); QCF Diploma ; Level 1 QCF Certificate; Level 1 QCF Award ; Level 1 Foundation 14-19 Diploma ; Functional Skills Certificate in Adult Literacy, Numeracy, ESOL at Level 1 ; Level 1 Key Skills ; Level 1 Principal Learning ; Introductory Diploma ; Introductory Certificate ; GNVQ Foundation NVQ Level 1 (Code 1)Full Level 2 Full Level 2 GCSE/O Level (5 or more GCSEs grades A*-C) GCSE (9-1) (5 at grade 4 or above) 2 or 3 AS Levels (for AS qualifications regulated before 1 September 2015) ; CSE Grade 1 (5 or more) ; 1 A Level ; Higher 14-19 Diploma ; QCF Diploma level 2 ; QCF Certificate level 2 at 13 or 14 credits undertaken before 2014 to 2015 Level 2 ; Principal Learning ; NVQ level 2 ; GNVQ Intermediate ; QCF Certificate level 2 at 15 credits and above (Code 2)Full Level 3 Full Level 3 A Levels (2 or more advanced level passes) ; 4 or more AS Levels (for AS qualifications regulated before 1 September 2015) ; QCF Diploma Level 3 ; QAA Access to HE Advanced ; 14-19 Diploma ; GNVQ Advanced ; NVQ level 3 AVCE double award; QCF Certificate at Level 3 which is 30 to 36 credits From 1 August 2015 ; vocational qualifications of 300 GLH or more (Code 3)Level 4+ Level 4+ QCF Qualifications at level 4; Certificates of higher education (code 10) Foundation Degrees (L5) ; Bachelor’s degrees; graduate certificates and diplomas (L6) (Code 12) Doctorates / Masters (L7) (Code 13) Save and Continue Later D: ELIGIBILITY & SUITABILITYthis section will identify if you are eligible for government funding1. Have you been lawfully living in the United Kingdom or any other member state of the European Union for the last three years? (excluding holidays)?YesNo2. Were you born or do you have citizenship (hold a passport in) of either the United Kingdom or any other member state of the European Union/Area or have right to abode or leave to remain in the UK?YesNo3. Are you a refugee or asylum seeker or believe you are eligible in line with additional conditions below*YesNoNationalityAs part of government funding requirements, we will require details of a form of ID, either passport or Birth certificate details. Please complete one of the two rows belowPassport No:Country of IssueExpiry Date Date Format: DD slash MM slash YYYY Birth Certificate Number:4. Are you currently in full time compulsory Education? (this means still in year 11)YesNo5. Will you be in any other funded training programme at the time of planned start? (e.g. College, Traineeship, A Levels, Apprenticeship, University)YesNo6. If yes to the above is this an Adult Education Budget funded programme in a subject unrelated to your Apprenticeship outside of work hours and with less than 4 weeks remaining?YesNo7. Do you have any restrictions regarding your right to work in the UK? I.e. a limit to your residency statusYesNoIf you answered yes to any of questions 3-7 above please provide further details including dates of entry and date leave expiresAdditional Conditions on eligibilityGuidance notes on Eligibility for Programmes To be an Apprentice on one of our programmes you must have the right to work in England or be one of the following: - A UK Citizen - A citizen of a country within the European Economic Area (EEA) (including other countries determined within the EEA or those with bilateral agreements), or have the right of abode in the UK, and have been ordinarily resident in the EEA (including other countries determined within the EEA or those with bilateral agreements), for at least the last three years - a non-EEA citizen with permission from the UK government to live in the UK, (not for educational purposes) and have been ordinarily resident in the UK for at least the previous three years before the start of learning If you are not in any of these categories please contact us for more information as you may still be eligible: - By telephone on 0333 577 2557 - By post at Umbrella Training, Unit 21, The Joiner's Shop, The Historic Dockyard, Chatham, Kent, ME4 4TZ Save and Continue Later E: PRIOR LEARNING / EXPERIENCEthis section will help us identify the starting point of your programmePlease indicate if any of the following apply to you: I have no previous work experience in the subject I am applying for or have work experience but for less than one month I have more than one month’s work experience but it is not in the subject I am going to train in I have more than one month’s work experience and it is in the subject area I am going to train in (e.g. you have been employed in the industry and have some skills and learning in relation to that industry requiring further skills analysis) I have previously been on either an Apprenticeship or Traineeship in this subject area Why do you want to be an Apprentice?Insert here a brief summary of the reason you want to be an Apprentice and where you see your career going in future? It will help identify what programme will be suitable for you. Save and Continue Later F: ADDITIONAL INFORMATIONEqual Opportunities MonitoringThis information is requested by the Government and is for statistical monitoring of adequacy & sufficiency, you can select not to respond. English, Welsh, Scottish, Northern Irish or British (31) Irish (32) Gypsy or Irish Traveler (33) Any other white background (34) White and Black Caribbean (35) White and Black African (36) White and Asian (37) Any other mixed or multiple ethnic background (38) Indian (39) Pakistani (40) Bangladeshi (41) Chinese (42) Any other Asian background (43) African (44) Any other Black / African or Caribbean background (46) Caribbean (45) Arab (47) Any other ethnic group (98) Prefer not to say (99) Save and Continue Later G: SUPPORT NEEDSThis section does not affect your application to the programme and you do not have to complete this section if you do not wish to, though it does help us tailor the learning package offered and provide you with additional support should you need it so please be honest. You can always ask for more support when you feel you need it.Tick any of the below that applyLearning Difficulties, Disabilities and Health Problems I have a visual impairment (4) I have a hearing impairment (5) I have a disability affecting mobility (6) I have profound complex disabilities (7) I have social and emotional difficulties (8) I have mental health difficulties (9) I have a moderate learning difficulty (10) I have a severe learning difficulty (11) I have dyslexia (12) I have dyscalculia (13) I have Autism spectrum disorder (14) I have Asperger’s syndrome (15) I have a temporary disability after illness (e.g post viral) or accident (16) I have speech, language and communication needs (17) I have another physical disability not stated here (93) I have an other specific learning difficulty (e.g. Dyspraxia) (94) I have another medical condition (e, g. epilepsy, asthma, diabetes) (95) I have a learning difficulty non specific (96) I have another disability not stated here (97) I prefer not to say (98) Having looked at these difficulties, disabilities and health problems please indicate which if any of the following apply to you: I believe I have a learning difficulty, disability or health problem (LLDD 1) I do not consider myself to have a learning difficulty, disability or health problem (LLDD 2) I prefer not to say (LLDD 9) Have you ever been in receipt of the following? Your programme may be entitled to additional funding A Section 139A Learning Difficulty Assessment (LDA)? An Education Health Care Plan (EHCP)? Special Education Provision? Statement of Special Educational Needs? Have you been in the care system? Your programme may be entitled to additional funding I am 16 or 17 have been looked after by the local authority/Health and Social Care Trust for at least a period of 13 weeks since the age of 14, and who is still looked after I am 16 or 17 who has left care after their 16th birthday and before leaving care was an eligible child I am between 18 and 25, a former relevant child - who, before turning 18, was either an eligible or a relevant child, or both. Are you happy for this information to be shared with your employer?YesNo Save and Continue Later H: HOUSEHOLD STATUSThis section is requested by government for non-Apprenticeship programmes for statistical monitoring purposes. Do not complete this for Apprenticeship programmes and you can also choose not to respondTick any of the following statements that describe your household status? (or leave blank if they do not apply) I confirm that I wish to withhold this information No household member is in employment and the household includes one or more dependent children (aged 0-17 or a student aged 18-24) No household member is in employment and the household does not include any dependent children or students I live in a single adult household with dependent children None of the above applies to me Save and Continue Later LEARNER DECLARATION & AGREEMENT FOR USE OF INFORMATIONHow We Use Your Personal Information We will use your information in line with the government statement below and our own policy as available at: https://www.umbrellatraining.co.uk/wp-content/uploads/2018/10/GDPR-Privacy-Policy-New-Version-2018-2019.pdf which explains how your data is used, who will have access and for how long. We only request information that is legitimately needed for the management of your planned programme. For more information about how your information is processed, and to access your Personal Learning Record, please refer to: https://www.gov.uk/government/publications/lrs-privacy-notices How the Government will use your Personal Information This privacy notice is issued by the Education and Skills Funding Agency (ESFA), on behalf of the Secretary of State for the Department of Education (DfE). It is to inform learners how their personal information will be used by the DfE, the ESFA (an executive agency of the DfE) and any successor bodies to these organisations. For the purposes of relevant data protection legislation, the DfE is the data controller for personal data processed by the ESFA. 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. The English European Social Fund (ESF) Managing Authority (or agents acting on its behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training. You can agree to be contacted for other purposes by ticking any of the boxes below: Further information about use of and access to your personal data, and details of organisations with whom we regularly share data, information about how long we retain your data, and how to change your consent to being contacted, please visit: https://www.gov.uk/government/publications/esfa-privacy-notice Learner DeclarationI confirm that all the information on this form and my application is correct and I wish to be considered for an interview to discuss a relevant programme of learning. I have read and understand the notice below on how my data and information will be used and consent to the Provider requesting and viewing my Personal Learning Record for the purpose of determining my appropriate learning programme and have selected my contact preferences below Please confirm your agreement with the above by ticking this box so we may proceed with your application Contact Permissions I agree to be contacted for courses or learning opportunities I agree to be being contacted for surveys and research I agree to be being contacted by Post I agree to be being contacted by Telephone I agree to be being contacted by Email Full NameSignaturePARENT / GUARDIAN CONSENT (Only if applicant is aged 15 or under)Parent / Guardian Agreement for the Application to be processed (if applicant is aged 15 or under) I agree understanding with the use of information statements above and consent to my child/charge applying for the programme and wish this to progress. Full NamePositionSignatureContact Phone NumberContact Permissions I agree the applicant can be contacted for courses or learning opportunities I agree the applicant can be contacted for surveys and research Contact PermissionsI agree the applicant can be contacted by the following methods By Post By Telephone By Email Contact PermissionsI agree to be contacted in the following methods in relation to this application By Post By Telephone By Email WHAT NEXT?Please complete the learning styles assessment overleaf and send this whole form to us. You will then be asked to complete a Skills Analysis in the subject area of the Apprenticeship you have applied for. You will also complete an initial assessment of Maths and English and we will then discuss the results in an interview where we will deliver information, advice and guidance regarding your career development and Apprenticeship opportunities. 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