Application Form

Location (more than one route can be selected)
Swadlincote CentreBurton on Trent CentrePinxton CentreRipley CentreBarlborough CentreStaveley Centre

Name of Course/Occupational Area:

Please tick the box below if you do not know which course you want to study
Course Not Known

Title:
---MrMrsMissMs

Surname:

Forenames (in full):

Previous Surname (if changed):

Nationality:

Date of Birth:

Current Address:

Email address:


Home Tel No. (incl Code):

Mobile:


National Insurance No:

Have you been living in the UK for the last 3 years?
YesNo

Normal country of residence:

Date of arrival in UK/EU:

Employment Status:
Full TimePart TimeUnemployed

Do you earn less than £17,004 per annum
YesNo

Title:
---MrMrsMissMs

Initials:

Surname:

Relationship to Applicant (parent, etc):

Daytime Tel No (incl area code):

Mobile No:

Chameleon School of Construction can offer a wide range of support to help learners on their course. We welcome learners with disabilities and learning difficulties (including, for example, Dyslexia, Epilepsy, Mobility difficulties and Mental Health problems).

If you consider that you may need some additional support, please complete the following questions:

Do you consider yourself to have a learning difficulty, disability or medical condition that may affect your studies? (eg. Use a wheelchair, have Dyslexia etc)

YesNo

If yes, please specify the nature of your condition. This will help us to best assess your requirements.

Will you require any alternative arrangements to assist you at initial assessments/interview?

YesNo
If you ticked yes, we will contact you to discuss.

I agree for the relevant details above to be passed to appropriate Chameleon School of Construction staff in order to assess possible support requirements.

YesNo

(If undecided, say so, but also indicate where main interests lie)

Give details of any employment, full-time (F/T), part-time (P/T),
Saturday (S), work experience (WE)

Company:

Duties:

Date:

Hours:
---Full TimePart TimeSaturdayWeekend

Company:

Duties:

Date:

Hours:
---Full TimePart TimeSaturdayWeekend

Company:

Duties:

Date:

Hours:
---Full TimePart TimeSaturdayWeekend

Company:

Duties:

Date:

Hours:
---Full TimePart TimeSaturdayWeekend

Company:

Duties:

Date:

Hours:
---Full TimePart TimeSaturdayWeekend

Company Name:

Contact Name:

Contact No:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

The new General Data Protection Regulation came into effect on May 25th 2018 and we’re letting you know how we collect, protect and handle your personal data.

We collect your data to enable us to keep in touch with you about the work that Chameleon School of Construction Ltd do. Data is limited to work-related information, such as email address, phone number and organisation.

We collect your data when you share your information with us when registering for an event, expressing an interest in what we offer as an organisation and also when completing enquiry/application forms on our website. We take appropriate steps in accordance with the GDPR to protect your data. Access to the mailing list is limited and protected via the use of passwords. We do not sell data to any organisation.

You have many rights regarding your personal data, including seeing what data we access, and updating your information. You are able to unsubscribe at any time by emailing ‘unsubscribe’ to enquiries@chameleonschoolofconstruction.co.uk

You don’t need to do anything right now, but if you’d like to find out more you can request our privacy policy via email or please do not hesitate to get in touch.

From time to time the college may use your details to send you information.

Do you require this information?

YesNo

Do you have any previous spent or unspent criminal convictions (excluding traffic offences)?

YesNo

If yes, please give details (we may contact you to discuss further):

I confirm that the details on this form are accurate and complete. If offered a place, I agree to comply with the training centres policies and procedures when using training centres facilities and understand that full copies of these policies and procedures are available.

I AgreeI Disagree