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PERSONAL DETAILSName:Address:Post Code:Email address: Home Telephone Number:Mobile Telephone Number:National Insurance No:Nationality:APPRENTICESHIPS ON OFFER - Please indicate the apprenticeship you wish to apply for:Maintenance/Engineering Technician- Thornton Cleveleys Process Operator - Thornton CleveleysMaintenance/ Engineering Technician - RotherhamProcess Operator - RotherhamEDUCATION, TRAINING & WORK EXPERIENCEPlease give full details of the secondary schools/colleges/further education establishments Name of School/College/Further Education EstablishmentName of Head/PrincipalAddressQualifications being studied for or already takenSubjectGCSE, BTEC, A Level, GNVQ, NVQ or other types of qualificationGradesYear taken or expectedExpectedAchievedMathematicsIntegrated ScienceModular SciencePhysicsChemistryBiologyComputer ScienceCraft, Design TechnologyCraft, Design RealisationInformation TechnologyControl TechnologyEnglish LiteratureEnglish LanguageFrenchGeographyHistoryMusicGermanBusiness StudiesWork experience while at School or College?Company Name and AddressType of Work Experience From (MM/YY)To (MM/YY)Part time jobs while at School or College?Company Name and AddressType of EmploymentFrom (MM/YY)To(MM/YY)ADDITIONAL INFORMATIONUse this space to give as much additional information as you can to support your application. Continue on a separate sheet if necessary. Please give details of your personal achievements. For example, are/were you a School Prefect; on any project groups at school; Duke of Edinburgh Award Scheme; Guide/Scout Award etc.Please give details of any hobbies and interests you have outside of School/CollegeWhy an Apprenticeship? Please use this space to tell us in your own words, why you would like to undertake an Apprenticeship at Victrex.How did you become aware of this vacancy?Please use this space if there is anything else you would like to add in support of your applicationHEALTH RECORD / ADDITIONAL SUPPORT NEEDS To help to provide you with any additional support that you may need, please answer the following questions. If you need help to complete this section please contact the HR Partner at Victrex.Tick as appropriateYesNoDyslexicEpilepsyAsthma / BronchitisColour blindnessArthritis / RheumatismSkin complaintsHearing impairmentDiabetesPhysical injuries to back, arms or legsHeart problemsVisually impairedOther (if yes please specify below)Are there any adjustments that may be required for you to attend the selection tests?If so, please state here:DATA PROTECTION Victrex is committed to looking after, and shall process, your personal data in accordance with its data protection policies and procedures.? DECLARATIONI declare that the information I have given in this application is accurate and true. I understand that providing misleading or false information will disqualify me.Signature:Signature of Parent/Guardian: Date:Date: ................
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