Jack Petchey Foundation Work Experience Application Form

Personal Details

Title (Please select)

First Name

Last Name

Address

Date of Birth

Post Code

Date

Mobile Telephone

Email

Current occupation:

Please state:

Please state which School:

Are you seeking the placement:

What dates are you seeking a placement for:

Will this be your first experience in a working environment:

Are you familiar with the work of the Jack Petchey Foundation:

Have you ever received an Achievement Award or Jack Petchey Funding:

How did you find out about the Jack Petchey Foundation work experience placement:

Why do you want to carry out work experience placement at the Jack Petchey Foundation?:

What areas of the Foundation are you most interested in:

What do you hope to gain and achieve from your work experience placement:

What skills and qualities can you bring to the Foundation during your placement:

Will you require any additional support or requirements during your placement:

Please outline what support you require:

Application declaration and consent

I can confirm that the information in the application above is true and if I am under the age of 18 I have the consent of a parent / guardian to approach that Jack Petchey Foundation for a work experience placement:

Applicant signature

Date

Parent/guardian signature:

Date

Parent/carer contact details in case of emergency

Phone

Home Phone

Email

The Foundation endeavours to provide young people with an insight into the day to day running of the Foundation with a varied work experience placement at office situated at

Dockmasters House, 1 Hertsmere Road London E14 8JJ

Where possible the Foundation will aim to tailor the experience to the interests of the applicant as stated in the application form.

During the placement there may be the opportunity to work offsite with members of the team.
If this opportunity arises the Jack Petchey Foundation will discuss this in advance of the placement and obtain parent/guardian consent where relevant.

If the applicant has any questions or concerns about the placement, they may call the Foundation on 020 8252 8000 to discuss them.