Social Work Services – Nomination Form



Social Work Services – Nomination Form

If you are eligible for a Social Work learning event and are unable to complete an application form on connect then please complete the form below (please note fields marked with * are mandatory).

|Your FULL Name * | |

|Employee Number * | |

|Your FULL Work Address * | |

| | |

| | |

|Email Address | |

|(or how it appears in Outlook) * | |

|Daytime Telephone Number * | |

|Job Title * | |

|Event Title * | |

|List three preferred dates to attend * |1: |

| |2: |

| |3: |

|Further Information * | |

|(e.g. Working patterns, access requirements, | |

|supportive chair, Braille, loop system, specific | |

|coloured paper, translator, large print etc) | |

The following section is compulsory and MUST be completed in consultation with your line manager.

|Line Managers FULL Name * | |

|Line Managers email * | |

|Line Managers telephone number * | |

Please consider how this event will help improve BOTH your skills and the service we provide.

|Learning Objectives | |

| | |

| | |

Is your line manager aware of your application for this event, the time off you will require, and is supportive of you attending? Please note applications where the line manager is not both aware and supportive cannot be processed.

Please mark with x as appropriate: *

|No, my manager is not aware | |

|Yes, my manager is aware and supportive | |

|Yes, manager aware but will not support | |

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