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Learning Agreement – UKSPF Interview Skills Dorset Foods
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*
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1
Course Details
2
Contact Details
3
Personal Details
4
Employment Status
5
Prior Learning
6
Privacy Statement
7
Contact Preferences
8
Learner Declaration
Course Title:
*
Please select
UKD2145G – Interview Skills Dorset Foods – 29/08/2024 – Morning
UKD2146G – Interview Skills Dorset Foods – 29/08/2024 – Afternoon
UKD2147G – Interview Skills Dorset Foods – 02/09/2024 – Morning
UKD2148G – Interview Skills Dorset Foods – 02/09/2024 – Afternoon
UKD2149G – Interview Skills Dorset Foods – 20/09/2024 – Morning
UKD2150G – Interview Skills Dorset Foods – 20/09/2024 – Afternoon
UKD2144G – Interview Skills Dorset Foods – 23/09/2024 – Online
UKD2151G – Interview Skills Dorset Foods – 26/09/2024 – Morning
UKD2152G – Interview Skills Dorset Foods – 26/09/2024 – Afternoon
UKD2194G – Interview Skills Dorset Foods – 08/10/2024 – Morning
UKD2207G – Interview Skills Dorset Foods – 24/10/2024 – Morning
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Course Tutor
*
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Primary Learning Aim
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Learning Aim Title
*
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Start Date
*
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Planned End Date
*
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GLH
*
Name
*
Mr
Mrs
Ms
Miss
Mx
Title
Given Name
Family Name
Preferred Pronouns
Previous Family Name
Legal Sex
*
Male
Female
Date of Birth
*
DD slash MM slash YYYY
Address
*
Street Address
Address Line 2
Town
Post Code
Main Contact Number
*
Alternative Contact Number
Email Address
Emergency Contact Name
Emergency Contact Number
Ethnic Origin
*
please select
English/Welsh/Scottish/Northern Irish/British
Irish
Gypsy
Irish Traveller
Any Other White Background
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed/Multiple Ethnic Background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian Background
African
Caribbean
Any other Black/African/Caribbean
Arab
Any other Ethnic Group
Do you have a disability and/or learning difficulty?
*
Yes
No
Learning Support
If you consider yourself to have a disability or learning difficulty please tick any that apply.
Vision impairment
Hearing impairment
Speech, Language and Communication Needs
Disability affecting mobility
Profound complex disabilities
Social and emotional difficulties
Mental health difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Autism Spectrum disorder
Asperger’s Syndrome
Temporary disability after illness or accident
Other physical disability
Other specific learning difficulty
Other learning difficulty
Other medical condition
Other disability
Primary disability or learning difficulty
If you have ticked more than one option in the previous question, please select which of these you think will have the biggest impact on your course.
Please select
Vision impairment
Hearing impairment
Speech, Language and Communication Needs
Disability affecting mobility
Profound complex disabilities
Social and emotional difficulties
Mental health difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Autism Spectrum disorder
Asperger’s Syndrome
Temporary disability after illness or accident
Other physical disability
Other specific learning difficulty
Other learning difficulty
Other medical condition
Other disability
Support contact request
*
If you have indicated a medical condition, disability and/or learning difficulty, would you like us to contact you to discuss your additional support requirements?
Yes
No
What is your employment status?
*
please select
In paid employment
Unemployed looking for work
Unemployed not looking for work
In full-time education prior to the start of the course
Retired
How many hours are you employed for?
*
If you are on a zero hour contract please select the average hours you’ve worked per week over the past month.
please select
0 to 10 hours per week
11 to 20 hours per week
21 to 30 hours per week
31 hours or more per week
How long have you worked for your current employer?
*
Please select
Up to 3 months
6-11 months
7-12 months
More than 12 months
Please tick if you are self employed
*
Yes
No
Please tick if your gross annual salary less than £22,308
*
Yes
No
How long have you been unemployed for?
*
please select
less than 6 months
6-11 months
12-23 months
24-35 months
36+ months
Please select which (if any) benefits you are in receipt of?
*
Please select
Job Seekers Allowance (JSA) (Including NI credits)
Employment Support Allowance (ESA)
Universal Credit (earning less than £617 a month as a sole adult or £988 while in a joint claim with your partner)
Universal Credit – above the £617 (single) or £988 (joint) thresholds
Carer's Allowance
Personal Independent Payment (PIP)
Pension Credit
State Pension
Other state benefits, please specify
Not claiming benefits
Other state benefit:
*
Are you required to engage with the job centre or work coach?
*
Yes
No
National Insurance Number
*
This should be in the format of QQ123456C
Priority Group
Recurring Unemployment
Recently made redundant
At risk of redundancy
In or recently left care
Lone parent
Homeless
Looking after dependents
Recently left the armed forces
Living in temporary accommodation
Prior Attainment
*
Please indicate the highest level of qualification you have achieved in any subject.
Please select
Entry Level (entry level in basic, digital or functional skills)
Level 1 (GCSE grades D-G or 1-3 or less than 5 A-C or 4-9)
Level 2 (functional skills, ESOL, non-entitlement quals)
Full Level 2 (NVQ/Diploma/Certificate at level 2, 5 or more GCSE grades A-C or 4-9, or 3 AS Levels)
Level 3 (Vocational or technical skills at level 3)
Full Level 3 (NVQ/Diploma/Certificate at level 3, 2 or more A Levels or 4 or more AS Levels)
Full Level 4 (HNC or vocational or technical skills at level 4)
Full Level 5 (HND, Foundation Degree)
Full Level 6 (Honours Degree)
Full Level 7 and above (Doctorates, Masters, PGCE)
Other Qualifications
No qualifications
Are you taking part any other government funded training this year?
*
Such as an apprenticeship, skills boot camp, unversity degree, etc.
Yes
No
Details of training
*
Access to ICT & Digital Skills
Please consider your current ICT skills and rate how confident you feel.
Internet
Very confident
Fairly confident
Neither
Not very confident
Not at all confident
Email
Very confident
Fairly confident
Neither
Not very confident
Not at all confident
Word Processing
Very confident
Fairly confident
Neither
Not very confident
Not at all confident
Do you have regular access to a PC, laptop or table to help with your learning?
Yes
No
Do you have a reliable internet connection?
Yes
No
How we (S&L) use your Personal Information
Skills & Learning is compliant with Data Protection legislation and some of the information on this form will be disclosed to certain Government Agencies as requested such as the Department for Education (DfE). A copy of our privacy statement is available on our website,
https://www.skillsandlearningace.com/policies/privacy/
. You can request a copy of this document in an alternative format by contacting enquiries@salbcp.com or 01202 123444.
How the UK Shared Prosperity Fund use your Personal Information
The funding for your course is provided by the UK Government’s Ministry of Housing, Communities & Local Government through the UK Shared Prosperity Fund. These funds are distributed as grants by both Bournemouth, Christchurch and Poole council, as well as Dorset council. For further information about how they use your personal information please visit,
https://www.dorsetcouncil.gov.uk/-/dorset-council-privacy-notice
.
Data Protection and Privacy Notice Confirmation
*
I have read and understood this data protection and privacy notice.
Contact Preferences
We (or the Education & Skills Funding Agency) would like to send you information about our courses, learning opportunities and for surveys and research by post, telephone or email. If you agree to being contacted in this way please tick the relevant box(es) below:
Reason for contact
About courses or learning opportunities
For surveys and research
How contact is allowed
Preferred method of contact?
By post
By phone
By e-mail
We will use the contact details held to contact you with information relating to your course(s).
How did you hear about us?
Another organisations website
Brochure (door to door delivery)
Contacted by provider
Event
Referral
Skills & Learning Website
Targeted e-mail
Word of Mouth
Social Media
Learner Declaration
I declare that
The information I have disclosed is true and accurate to the best of my knowledge.
I agree to abide by the Skills & Learning responsible learner behaviour policy.
I will inform Skills & Learning of any unspent criminal convictions (please refer to the Learner Handbook for guidance).
I agree to inform Skills & Learning or any relevant change of personal circumstances.
I have read and understood the Skills & Learning Terms and Conditions (
https://www.skillsandlearningace.com/policies/terms-and-conditions
) and the Learner Handbook
https://www.skillsandlearningace.com/learning-with-us/learner-handbook/
I have been informed of and understand the entry requirements for my course, the guided learning hours, the nature and suitability of the course and how to contact Skills & Learning support & advice services.
I agree to sit the exam/assessment required to achieve the qualification (if appliable) and submit all required coursework.
I will undertake independent study and homework to help me progress quickly.
I will attend regularly and arrive on time.
I will help support the future funding of adult learning by providing feedback on the impact of having undertaken this learning programme.,/li>
Signature
*
Please draw your signature either with your mouse or if you have a touchscreen with your finger or stylus.
Date Signed
*
DD slash MM slash YYYY
Signing above confirms that the declarations you have made in this form are a true and accurate reflection of your circumstances.
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Staff Signature
*
Please draw your signature either with your mouse or if you have a touchscreen with your finger or stylus.
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Date Signed
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DD slash MM slash YYYY
I confirm that to the best of my knowledge, the information on this form is true and accurate.
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