Participant Registration

Complete ALL sections. DO NOT leave any section Blank

SECTION 1  		PARTICIPANT DETAILS

Accommodation

SENDER		PROGRAMME DATES	
PARTICIPANTS NAME		Male / Female	
HOME ADDRESS		
NAME And PHONE NUMBER OF PERSON TO BE CONTACTED IN AN EMERGENCY	
	
Phone  Home		Mobile Phone No		
DATE OF BIRTH  	AGE		Do you Smoke?	YES    NO	
DO YOU HAVE ANY ILLNESS OR INJURY? 	YES NO	 	GIVE FULL DETAILS  Below.	

Do You take any Medicines?	
List the names of your medicines	

ARE YOU ALLERGIC TO ANY OF THESE?	DO YOU EAT THIS FOOD   	
	YES	NO	DETAILS		YES	NO	
DUST				RED MEAT			
POLLEN				WHITE MEAT			
FEATHERS				FISH			
ANIMALS				DAIRY			
MEDICATIONS				EGGS			
FOODS				ARE THERE ANY SPECIAL FOODS YOU EAT EVERY DAY	
OTHER ALLERGY					

Is there any other information that will help us _________________________________________________

SECTION 2  		DECLARATION

I the undersigned confirm that:
1.  All details on this form are true.
2. I am in good physical and mental health
3. I have never been convicted of a criminal offence.
4. I understand that what I have written here is the basis of my training experience
5. I accept Full responsibility for the content of this form

FIX

PHOTO 

HERE	

Signed_____________________Date__________		

SECTION 3 		WORK PLACEMENT APPLICATION

EDUCATION
Please list the subjects you studied together with exams, and grades
COLLEGE/VOCATIONAL SCHOOL
SUBJECT	 MOST RECENT EXAM	DATE	GRADE	

				

				

FINAL DIPLOMA  ______________________________DATE_____________________________

What part of the course do you enjoy most? ___________________________________________

______________________________________________________________________________

OTHER QUALIFICATIONS AND TRAINING 

WHAT COMPUTER SKILLS DO YOU HAVE? (List Programmes you can use)

PREVIOUS WORK EXPERIENCE

Please tell us as much information as you can 

EMPLOYER 1____________________________________DATE__________________________

What did you do there? ___________________________________________________________

______________________________________________________________________________

EMPLOYER  2___________________________________DATE__________________________

What did you do there?___________________________________________________________

______________________________________________________________________________

WORK PLACEMENT (READ THIS)
Please tell us about three types of companies (eg insurance, bank, printers) that you would like to work with.  Please also tell us the type of work you would like to do and what you would like to learn. It is important that you tell us as much information as possible so that we can try to do our best for you.

SECTION 3  		WORK PLACEMENT APPLICATION (Contd)

YOU NEED SOME BASIC RELEVANT SKILLS OR TRAINING  TO BE ABLE TO WORK IN AN AREA
Eg. You need computer skills for an office You need Childcare experience to work with children

1ST CHOICE TYPE OF COMPANY_______________________________________________________

WHAT KIND OF WORK ARE YOU INTERESTED IN DOING?___________________________________

_____________________________________________________________________________________

WHAT WOULD YOU LIKE TO LEARN?_____________________________________________________

______________________________________________________________________________________

2nd CHOICE TYPE OF COMPANY________________________________________________________

WHAT KIND OF WORK ARE YOU INTERESTED IN DOING?____________________________________

______________________________________________________________________________________

WHAT WOULD YOU LIKE TO LEARN?______________________________________________________

3rd CHOICE TYPE OF COMPANY________________________________________________________

WHAT KIND OF WORK ARE YOU INTERESTED IN DOING?____________________________________

 _____________________________________________________________________________________

WHAT WOULD YOU LIKE TO LEARN?_____________________________________________________

______________________________________________________________________________________

Why do you want to come on the Programme?_________________________________________

INTERESTS AND HOBBIES   What interests and hobbies do you have?
1._____________________________________________________________________________

2._____________________________________________________________________________

3._____________________________________________________________________________

SECTION 4 		CHECLIST  
1.	Please Ensure that you have answered every question and that no box is left blank.
2.	This document must be SIGNED IN INK by the participant TYPED SIGNATURE IS NOT ACCEPTABLE
3.	Attach a current CV to this application
4.	Attach your photograph
5.	Complete the English test
6.	Attach your English Test
7.	Attach Police Clearance if Required
8.	PLEASE USE INSERT KEY IF TYPING THE FORM
Do NOT Send this form unless you have completed ALL 8 items on the checklist
SECTION 5  		ENGLISH TEST

Example
 
This ____________a book
1. Is   2.  Am    3. Are   4. be	
   1	In each question only one of the 4 answers is correct. 
Choose the correct answer
Place 1 2 3 or 4  in the answer box  on the right	
There are twelve of us, so __________get into the car at the same time
1.	we may not all         2.  all we may not     3. all we can’t 4. we  can’t  all		
Her Children tell her that_____________old to drive a car
1. she’s getting to   2. she gets too    3. she’s getting too   4. she gets so		
When there is a public rocket service to the moon her father promised _____________her there
1. Bringing     2.   Taking    3. To bring  4.  to take		
______________ at the moment I’ll go to the shops.
 1. As it doesn’t rain  2. For it doesn’t rain   3. As it isn’t raining   4. For it isn’t raining		
In a shop ________________  customers
1. It is important pleasing  2.  it is important to please  3. There is important pleasing  4. there is important to        please		
Your bicycle shouldn’t be in the house!  ___________
 1. Take it out   2.  put it off  3. Get it out  4.  take it away		
He’s a good Guitarist but he plays the piano __________
1. quiet well  2. much better  3. very good  4.  too hardly		
Molly doesn’t eat fish_________
1. John doesn’t that either   2.  so doesn’t John  3. Neither does John   4.  John doesn’t too		
She always buys  _______my birthday
1. Something awful for    2. anything nice to   3. Something awful to  4. anything nice for		
She hardly ever eats _______ potatoes
1. neither bread nor  2. bread or   3. either bread or  4. or bread or		
I________ to your letter of the 15th
1. would like to reply  2. like to reply   3. am wanting to reply  4. would like replying		
Your letter ____________
 1. has arrived 2 days ago   2. arrived 2 days ago  3. arrived since 2 days  4. has arrived since 2 days		
If I________ about it earlier I would have told you
                  1.  knew  2. would know   3. would have known  4. had known		
I’ll ring you as soon as I ________there               
               1.   Get  2.  shall get   3. Will  have got   4.  will get		
John Marshall is a friend of mine. You _____him last year when you were in England
1. may met   2. can meet   3. may have met   4.  can have meet		
He didn’t thank me for the present. That’s _____ annoyed me
1. what   2. the which  3. The thing what  4.  that which		
I’ll have to buy ___________trousers
1. two 2. a couple of   3. A    4.  a pair of		
She looks ______________
1. pleasantly    2. that she’s pleasant   3. pleasant    4. to be pleasant		
I’ve been looking for you ____________
1. everywhere  2. for all places    3. anywhere   4. in all places		
Send him to the bakers ________ the bread
1. for buying  2. in order he buys  3. to buy  4. for to buy		
He didn’t know___________ or go home
1. If to wait  2. whether to wait   3. To wait    4. if that he should wait		
If you__________help you, you only have to ask me 
1. want I should   2. want me to   3. are wanting me to  4. want that		
I’m going to the theatre tonight. So _______ I
1.  do   2. can   3. will   4.  am		
He wants to get a better _____ and earn more money
1. employ    2. Work   3.  job  4.  employment		
I didn’t hear what he was _________
1.  Speaking    2. Saying   3. Talking   4. Telling		
NAME

	Date	

DID  YOU READ THE CHECKLIST?
Do NOT Send this form unless you have completed the Checklist