In-Comm Business Services & In-Comm Training Services

Learner application form

Are you a looking for a position as an apprentice? Are you a school-leaver, or are you about to leave school? If so, complete our Learner Application Form and someone will be in touch!

If you have any questions about the form, or would like to talk to someone, please feel free to call us.

Telephone 01922 457686
Fax 01922 453211

Email sales@in-comm.co.uk

About you
Title
Surname
Forenames
Address
Postcode
Telephone
Mobile
Email address
Nationality
Date of birth

What training programme are you interested in?
Where did you hear about In-Comm?

Education
Name of present school (or last attended)
Years attended
Careers office

Your grades
Subject	Predicted grade	Actual grade

Further Education
Course	Location	From	To

Training and Employment History (include any part-time jobs & work experience)
Course / Employer	Reason for Leaving	From	To

A little more about you

Do you have any holiday commitments?

List your main hobbies, sports, interests and membership of any clubs or teams

Medical History
Are you in good health? (If no, please give details below)

Do you suffer with any disability? (If yes, please give details below)

Are you registered disabled? (If yes, please give further details below)

Have you received major hospital treatment? (If yes, please give details below)

Do you suffer with any other medical conditions? (If yes, please give details below)

Do you wear contact lenses?
Are you colourblind?

Please give any additional information to support your application

Educational Maintenance Allowance (EMA)
Are you registered for EMA?
Do you have a current EMA contract?
Do you require an EMA application form?

Equal Opportunities
In-Comm is an equal opportunities provider. For statistical purposes only would you please state your ethnicity from the list.

Declaration

I declare that the above information is correct and I understand that misleading statements or deliverate omissions may be sufficient grounds for cancelling any agreements made. I understand that completion of this form does not constitute an offer of placement.