Enrol in our Employability Programme by filling in the form below: Employability Enrolment FormFirst NameLast NameDaytime Telephone NumberMobile NumberEmailDate of BirthGenderAddressAddress Line 1Address Line 2CityCountyPostcodeCurrent Employment Tick this box if you consent to us taking and using your photograph for publicity purposes. (Please note: Photographic files will be stored within the MV Library for up to 10 years. Tick this box if you consent to us using your learner story for publicity purposes. Your Ethnicity- Select -White - English/Welsh/Scottish/Northern Ireland/BritishWhite - IrishWhite - Gypsy/Irish TravellerWhite - Any Other White BackgroundMixed/Multiple Ethnic Group - White and Black CaribbeanMixed/Multiple Ethnic Group - White and Black AfricanMixed/Multiple Ethnic Group - White and AsianMixed/Multiple Ethnic Group - Any other Mixed/Multiple Ethnic BackgroundAsian/Asian British - IndianAsian/Asian British - PakistaniAsian/Asian British - BangladeshiAsian/Asian British - ChineseAsian/Asian British - Any other Asian BackgroundBlack/African/Caribbean/Black British - AfricanBlack/African/Caribbean/Black British - CaribbeanBlack/African/Caribbean/Black British - Any other Black/African/Caribbean BackgroundOther Ethnic Group - ArabOther Ethnic Group - Any other Ethnic GroupOther Ethnic Group - Not known/Prefer not to sayYour NationalityYour First LanguageDo you have a learning difficulty/disability? Yes NoPlease select a difficulty/disability if you ticked yes above.- Select -Visual ImpairmentHearing ImpairmentDisability affecting mobilityProfound/complex disabilitesSocial and emotional disabilitiesMental health difficultiesModerate learning difficultiesSevere learning disabilityDyslexiaDyscalculiaAutism spectrum disorderAsperger's syndromeTemporary disability after illness/accidentSpeech, language and communication needsOther physical disabilityOther specific learning difficulty 95Other medical conditionOther learning difficultyOther disabilityPrefer not to sayNot providedTo help us support your needs, please indicate your main difficulty/disability in the box below: Prior Attainment- Select -No Formal QualificationEntry LevelBelow Level 1 (other qualifications)Level 1 (GCSEs, Grade D and Below)Level 2 (5 GCSEs Grade C and above, up to 3 AS-Levels)Level 3 (2 or more A-Levels or equivalent)Level 4 (First Degree)Level 5 (Post Graduate Qualification)Level 6Level 7Other Qualification/Level Not KnownDo you have a GCSE grade A*-C in English? Yes NoDo you have a GCSE in A*-C in Maths? Yes NoStatus - Tick all the applyI receive Job Seeker's AllowanceI receive Universal CreditI receive Employment and Support Allowance (WRAG - Work related activity group)I receive a state benefit other than JSA, Universal Credit or Employment and Support Allowance (WRAG)Unemployed and looking for workUnemployed and not looking for workI am unemployed and in receipt of state benefit and wish to enter employmentIf you are in employment, please provide the name of the employer:Job TitleTown of Employer I am in seasonal employmentDid your employer recommend this course to you? Yes NoPlease select your current employment status:- Select -Employed for 0-10 hours per weekEmployed for 11-20 hours per weekEmployed for 21-30 hours per weekEmployed for more than 31 hours per weekEmployed for up to 3 monthsEmployed for 4 to 6 monthsEmployed for 7 to 12 monthsEmployed for more than 12 monthsIn full time education or training prior to enrolmentSelf-employedPrivacy Notice - How we use your personal information This privacy notice is issued by Magna Vitae (MV) to inform learners how their personal information will be used. For the purposes of relevant data protection legislation, MV is the data controller for the processing of your personal data. Your personal information is used by MV to exercise its functions and to create and maintain a unique learner number (ULN). Your information will be securely destroyed after it is no longer required for these purposes. Your information mat be used for education, training, employment and well-being related purposes, including for research. The Coastal Communities Fund, or agents acting on their behalf, may contact you in order for them to carry out research and evaluation to inform the effectiveness or training. Your information may also be shared with other third parties for the above purposes, but only where the law allows it and the sharing is in compliance with data protection legislation. You can agree to be contacted by other third parties by ticking any of the following boxes:About courses or learning opportunitiesFor surveys and researchBy postBy phoneBy emailFurther information about use of and access to your personal data, details of organisations with whom we regularly share data, information about how long we retain your data, and how to change your consent to being contacted, please visit: https://www.gov.uk/government/publications/esfa-privacy-notice Data Protection: Data Protection. Lincolnshire County Council is registered with the Information Commissioner under the General Data Protection Act Regulation (GDPR) 2018, and all information will be processed in accordance with the Act. Learner’s Declaration I understand that this course is a unique opportunity and my mentor can withdraw me from the programme if my commitment is questioned. I agree to comply with all health and safety requirements and that the provider reserves the right to deny access if I fail to complySigned by learnerDateSubmit Form