Playwork Level 3 Upskilling 
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Email *
Full name *
1st line of address *
Town/City *
Postcode *
Contact Number *
Date of Birth *
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Gender *
National Insurance Number *
Ethnic Origin: Please describe your ethnic origin by ticking the appropriate box below: *
Under the Disability Discrimination Act 1995 a person is considered to have a disability if he/she has a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day to day activities. Do you consider that you meet this definition of disability? *
If you answered yes above, please tick the appropriate box below
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Community Background: (tick as appropriate) *
Labour Market Status: *
Highest Qualification held: *
Any other training / qualifications held relevant to working with children? *
Marketing Consent:  From time to time, we would like to email you information about other relevant training programmes and potential funding opportunities.  Please indicate your preferences below.  Please note that we will hold your data securely and only share relevant information with Belfast City Council for funding requirements. *
EMPLOYER DETAILS: 
These next questions are to be completed by the line manager of the candidate. What is the current position of the candidate? (EG: Playwork Assistant, Room Lead etc)
 *
Contracted number of hours per week? *
Is this position temporary or permanent? *
Required
Employment start date & current salary *
Organisation name *
Name of line manager and email address  *
Organisation address  *
Organisation phone number  *
Number of staff employed in the organisation? *
Please be aware that this programme is about career development of candidates.  By completing this form you, as the employer, are committing to ensure opportunities for promotion or enhanced conditions are available by the end of this programme. Please confirm your agreement to this commitment. *
Required
Please explain briefly how the completion of this programme will provide access to these opportunities. *
Please provide details of any entry levels opportunities for new staff, which may be creating as a result of existing staff progressing. *
For the candidate to complete in conjunction with your line manager. Please explain why you would like to take part in the programme? *
Please confirm that you understand this programme is about progression, and that you intend to take up senior posts, or other enhanced employment opportunities as provided, *
Required
Please confirm the candidate meets the following criteria: *
Required
Participant• I am committed to fully participate on the aspects of the programme including workshops, workplace assessment, developmental activities related to the qualification with the intention of completion within 12 months of commencing programme• I am willing to progress within the Child Care / Playwork industry should a suitable vacancy arise• I meet all pre-conditions stipulated by the employer• I have the right to work in the UK• I am not participating on any other initiative which would exclude me from participating in the Playwork Upskilling academy.• I am committed to fully participate in 12 months mentoring that will include work visits *
Required
Employer• Our organisation is committed to fully participate on the aspects of the programme including providing the participant access to workshops, workplace assessment to ensure the intended completion within 12 months of commencing programme• Our organisation will provide the participant with the opportunity to apply for any suitable vacancies which may arise in the setting• Our organisation is not participating on any other initiative which would exclude the participant from taking part on the Playwork Upskilling academy• Our organisation will provide an opportunity of 12 months managerial duties to include supervision of staff and any other duties that may be required• I am committed to fully participate in 12 months mentoring that will include work visits.  Owner / Manager willing to provide a reference to support applicant in completing Level 3 Diploma. Employer/setting willing to facilitate onsite visits. Use of additional information from Line Manager to support practical assessment requirement. Employer/setting willing to support learner in completion of work placement products.  Employer/setting willing to support appropriate time requirements for learner to complete assignments.  Confirm participant’s competence in written and spoken English and Numeracy.               *
Required
Signed - Employer *
Signed - Participant *
Date *
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