Course Application Form
Section 1: Company Details
As listed on Companies House
Company Name
Address
Street Address
Street Address Line 2
City
County
Postal Code
Company Number
Number of Employees
Nominated Finance Representative
Finance Email
Phone Number
*
-
Area Code
Phone Number
Are you a Levy Payer?
Yes
No
Don't know
Section 2: Learner Details
Learner Details
Rows
Full Name
Course Applying for
Date of Birth
Email address
Mobile Number
N.I. Number
Gender
Address (inc Postcode)
Contracted Weekly Hours
Nationality
Has Visa
1
2
3
4
5
6
7
8
9
10
Line Manager Details
Rows
Full Name
Job Title
Email
Phone Number (Mobile)
Learner 1
Learner 2
Learner 3
Learner 4
Learner 5
Learner 6
Learner 7
Learner 8
Learner 9
Learner 10
Section 3: Health & Safety
Required to access government funds
Do you have a Health & Safety Policy
Yes
No
Has this been reviewed in the past year?
Yes
No
Does your business have adequate risk assessments in place (e.g. Manual Handling, PPE, Fire Safety)?
Yes
No
Have employees been provided with required Health & Safety information?
Yes
No
Do you have an accident book and first aid kit on site?
Yes
No
Who is your nominated Health & Safety Representaive?
Submission Details
Onboarding point of contact
Name
First Name
Last Name
Phone Number
Date
-
Month
-
Day
Year
Date
Please attach a copy of Employer Liability Insurance
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