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Warriner School Work Experience Student Information 5th to 9th JUNE 2017
Fill in when you have secured a work shadowing placement.
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We agree to the above student undertaking work experience. We understand we will receive confirmation of the placement with further details at a later date.
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We have provided any relevant information as requested above. We have received the information for parents/ guardians about Work Experience. We understand that the parents/ guardians have responsibility for safety whilst the student is travelling to and from Work Experience, unless separate arrangements have been made by Oxfordshire Local Education Authority.
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We understand that both Oxfordshire Local Education Authority and ‘the employer/placement provider’ will endeavour to ensure that so far as is reasonably practicable all necessary Health and Safety measures will be taken during the placement.
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We understand that the employer/ placement provider must satisfy the insurance, health and safety requirements of the Oxfordshire Work Experience Scheme.
Mr N.Smith
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* Indicates required question
Name
*
First then Surname
Your answer
Tutor Group
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10X-XXX
Your answer
Home address
*
County i.e. Oxfordshire
Your answer
Home address
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Town i.e. Banbury
Your answer
Home address
*
House number or Name
Your answer
Home address
*
District i.e. Bloxham
Your answer
Post code
*
Your answer
Medical conditions that employer needs to be aware of.
*
Any, allergies, asthma, claustrophobia, colour blindness, epilepsy, diabetes, eczema, learning difficulties etc if none please state
Your answer
Home address
*
Street, Road, close etc
Your answer
Name of Organisation/ employer who the placement is with
*
Full company name
Your answer
Company address
*
Unit 2, Hope Ind Est, etc
Your answer
Company address
*
Street name
Your answer
Company address
*
District
Your answer
Company address
*
Town
Your answer
Company address
*
County
Your answer
Company address
*
Post Code
Your answer
Company phone number
*
Full std code required
Your answer
Name of contact in company
*
Mr J. Smith
Your answer
Company contact email address
*
Jsmith@placement.nt
Your answer
Title of contact
*
Director, Partner, Headteacher etc
Your answer
Date that agreed to placement
*
1st September 2015
Your answer
Type of placement offered
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e.g. working as a groom
Your answer
Parent/Guardian & Student Agreement (state you have read this)
*
See statement at the top of the form.
Yes
No
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