WORK SHADOWING APPLICATION FORM

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ELHT Virtual Work Shadowing Application Form
(Only Radiography available)

The Application:

For applicants under the age of 18, we will need permission from your parent/guardian/teacher to process your work experience request

Please Be Aware:

Please can you give at least 12 weeks’ notice when applying for work experience – if you are unable to provide your application within this timeframe we may not be able to facilitate your placement for your chosen date(s)
Due to the number of applications we receive, we are only able to arrange one placement per academic year to allow other students to undertake placements
In addition to the above point, we have restrictions on the amount of placements we can offer per month. Therefore we advise all applicants to apply as soon as possible (as we accept applications on a first come first serve basis)
We predominantly facilitate work experience placements between Monday and Friday
Please note we cannot guarantee work experience at ELHT due to the nature of the work. We aim to inform students of any changes to their placement as soon as possible to allow alternative plans to be made. We encourage students to arrange an alternative placement in case we are unable to facilitate their request.
Please note – if inadequate information is provided, your application will be declined

Data Protection and Confidentiality:

We may use your information for reporting purposes, however information is dealt with in the strictest confidence
We may contact you in regards to creating a case study based on your work experience to upload onto our website

CANDIDATE AND PLACEMENT DETAILS

* Indicates required field

First Name *

Surname *

Address *

Town *

Postcode *

Email *

Contact Number *

Date of Birth *

Gender *

Do you have any learning disabilities/disabilities we may need to be aware of? *

Yes No

If yes, please state *

Ethnicity

White *

English/Welsh/Scottish/Northern Irish/British Irish Gypsy or Irish Traveller Any other White background

Mixed/Multiple ethnic groups *

White and Black Caribbean White and Black African White and Asian Any other Mixed/Multiple ethnic background

Asian/Asian British *

Indian Pakistani Bangladeshi Chinese Any other Asian background

Black/African/Caribbean/Black British *

African Caribbean Any other Black/African/Caribbean background

Other ethnic group *

Arab Any other ethnic group Option 3

Employment Status *

EMERGENCY CONTACT

Name *

Contact Number *

Relationship to you *

PLACEMENT

Where did you hear about work shadowing placements? *

Please state your availability over the next 2 months (please note - we are unable to facilitate placements over the weekends) *

What career are you aspiring towards? *

Please tell us why you are applying for Work Shadowing. This is your opportunity to promote yourself, to identify why you would like to gain work experience within ELHT. Please use this space to provide any supporting information to go with your application. This can be anything that is not already covered by the other questions on the form and may include interests, career aspirations, how the placement will benefit you, extra-curricular activities either within or outside of sixth form/college. *

CURRENT QUALIFICATIONS

Qualification Type and Result *

Are you currently studying? *

If yes, where are you studying? *

If yes, what are you studying? *

Do you plan on applying to university? *

If yes, which university is your first choice? *

Previous work experience or voluntary work within ELHT *

If yes, please include the department, date and location *

Your Declaration *

Yes

Work Experience Agreement to Trust Requirements
I have read and understood the above requirements.

PARENT/GUARDIAN DECLARATION

Your parent/guardian declaration *

Yes

Name *

I have read and understood the above requirements. I will ensure the student carries out these obligations and confirm that he/she is not suffering from any complaint, which might create a hazard to him/ herself or to those working with him/her. I give permission for my son/ daughter to attend the placement and observe during his/ her visit to East Lancashire NHS Trust.

Submit

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