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Qualification Details
Area
*
--None--
Health and Social Care
Personal Development for Employablity
Work Skills
Supported Internship
Traineeship
Level
*
--None--
Level 1
Level 2
Personal Details
Salutation
*
--None--
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
First Name
*
Last Name
*
Previous Family Name
Known As
*
Email Address
*
Gender
*
--None--
Male
Female
Prefer Not Say
Mobile
*
Home Phone
*
NI Number
*
Birthdate
*
Age Band On Start
*
--None--
Under 16
16-18
19-24
24+
Reason For Applying
*
Address
House No. & Street
*
City
*
County
*
Post Code
*
Identification
Type of ID
--None--
Birth Certificate
Current Benefits Agency Letter
Current Full UK Driving Licence
Current State Pension Notification Letter
Current UK / EU Photocard Driving Licence with Counterpart
Current Valid Full EU Passport
Current Valid Full UK Passport
Current Valid National ID Card
Current Years HMRC Tax Code Notification
Identification Number
Identification Expiry Date
Identification Seen By
Date ID Seen
Diversity Monitoring
Ethnicity
*
--None--
White British
White Irish
White Gypsy or Irish Traveller
Any Other White Background
Mixed - White and Black Caribbean
White and Black African
White and Asian
Any Other Mixed / Multiple ethnic background
Asian - Indian
Asian - Pakistani
Asian - Bangladeshi
Asian - Chinese
Any other Asian background
Black - African
Black - Caribbean
Any other Black / African / Caribbean background
Other - Arab
Any Other ethnic group
Not Provided
Other Ethnicity
Disability
*
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No disability
Asperger’s syndrome
Disability affecting mobility
Hearing Impairment
Mental health difficulty
Multiple disabilities
Other
Other medical condition
Other physical disability
Profound complex disabilities
Temporary disability after illness
Visual Impairment
Learning Difficulties
*
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No learning difficulty
Autistic spectrum disorder
Dyscalculia
Dyslexia
Moderate learning difficulty
Multiple learning difficulty
Other
Other specific learning difficulty
Severe learning difficulty
Other disability or learning difficulty
Any medication taken regularly
Education
Previous Learning Establishment
*
Are you currently in education?
*
--None--
Yes
No
If yes, what education are you taking part in?
GCSE English
*
--None--
High A* (9)
A* (8)
A (7)
B (6)
High C (5)
C (4)
D (3)
E/F (2)
G/U (1)
None
GCSE Maths
*
--None--
High A* (9)
A* (8)
A (7)
B (6)
High C (5)
C (4)
D (3)
E/F (2)
G/U (1)
None
Year Achieved GCSEs
Highest Qualification Achieved Level
*
Entry Level
Level 1 (Less than 5 GCSE’s/GCE’s at A-C)
Level 2 (5 or more GCSE’s/GCE’s at A-C)
Level 3 (2 or more A levels or 4 AS levels)
Level 4 (Degree/teaching qualifications)
No qualifications
Any Other Qualifications Achieved
Employment
Employment Status
*
--None--
In Paid Employment
Not In Paid Employment, looking for work and available to start work
Not In Paid Employment, not looking for work and/or not available to start work
Not known / not provided
If employed
How long have you been employed for?
--None--
Up to 3 months
4 to 6 months
7 to 12 months
Over 12 months
Weekly Hours Worked
--None--
0-10 Hours per week
11-20 Hours per week
21-30 Hours per week
31+ Hours per week
If unemployed
Length of Unemployment
--None--
Less than 6 months
6-11 months
12-23 Months
24-35 months
Over 36 months
Emergency Contact
Relationship
*
--None--
Parent
Carer
Spouse
Partner
Civil Partner
Friend
Other Family Member
Other
Contact Name
*
Home
*
Mobile
*
NOK Email
*
House NO. & Street
*
City
*
County
*
Post Code
*
Criminal Offences
Criminal Offences
*
--None--
Yes
No
If yes, please provide details
Do you have any charges pending?
*
--None--
Yes
No
If yes, please provide details
Household / Benefits
Household Status
*
--None--
No household member is in employment and the household includes one or more dependent children
No household member is in employment and the household does not have any dependent children
Learner lives in a single adult household with dependent children
Learner has withheld this information
None apply to me
Which of the following benefits are you claiming?
--None--
Jobseekers Allowance
Employment Support Allowance (Work Related Activity Group)
Universal Credit
Other benefit
Please state other benefit
Do you have an EHC Plan?
*
--None--
Yes
No
Eligibility Questions
Have you been a UK resident in the UK at all times within the last 3 years?
--None--
Yes
No
Are you a UK Or EEA Citizen or do you have the right to abode in the UK?
--None--
Yes
No
Have you been a resident in the EEA for at least 3 years?
--None--
Yes
No
Consent - Green Labyrinth require you to give consent to process your data
Privacy Policy
I give consent for Green Labyrinth to store & process my data in regards to my qualification
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Terms and Condition
I have read and agree to Green Labyrinth's terms and conditions
*
Contact Preference
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Photo Consent
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No
N/A