About Yourself. Please write anything you would like to describe about yourself.
About Yourself. Not looking for work and/or not available to start work ¨ Unemployed for: Less than 6 months ¨ 6-11 months ¨ 12-23 months ¨ 24-35 months ¨ 36 months or more ¨In receipt of JSA ¨ In receipt of ESA (WRAG) ¨ In receipt of UC because you are unemployed and are required to undertake skills training¨ per week ¨ ¨ Employed for 16-19 hours per week Employed for 20 hours or more per week ¨ Self Employed ¨ Employed for: Up to 3 months ¨ 4-6 months ¨ 7-12 months ¨ JSA (Job Seeker’s Allowance) ESA (Employment Support Allowance) WRAG (Work Related Activity Group) UC (Universal Credit) JSA (Job Seeker’s Allowance) ESA (Employment Support Allowance) WRAG (Work Related Activity Group) UC (Universal Credit) More than 12 months ¨ ¨ Have you previously enrolled on a course at Swindon College? No ¨ Yes ¨ ID Number: Unique Learner Number: Proof of ULN Title (Mr/Mrs/Miss/Ms/Dr): Gender: Male ¨ Female ¨ Surname: Xxxxxxxx(s): Home Address: Postcode: Years at Address: Date of Birth: Please specify: Please tick one box only: (must be completed) ¨ Entry Level e.g. Basic Skills ¨ Level 1 ¨ Level 1 e.g. NVQ 1 or 5 or more GCSEs D-G or fewer than 5 ¨ Full Level 2 e.g. NVQ 2, 5 or more GCSEs A*-C, 2 or 3 AS levels, ¨ Full Level 3 e.g. NVQ 3, 2 or more A levels ¨ Previous Address: Postcode: Level 4 e.g. NVQ 4 or HNC or Professional Diploma ¨ Level 5 e.g. Foundation Degree HND or N VQ 5 ¨ Nationality: Home Tel: Work Tel: Mobile Tel: Email Address: National Insurance No: Are you currently enrolled at another educational institution? No ¨ Yes ¨ If yes, please enter the institution: Have you been in full time education or training prior to this enrolment? No ¨ Yes ¨ Do you have any unspent criminal convictions? No ¨ Yes ¨ ‘Household situation – For 19+ Learners only’ Please tick the appropriate boxes: GP Name : GP Surgery: HHS1 - No household member is in employment and the household includes dependent children ¨ HHS2 - No household member is in employment and the household does not include dependent children ¨ HHS3 – The household includes only one adult with dependent children ¨ Prefer not to say ¨ None of the above applies ¨
About Yourself. Surname Forenames National Insurance Number Daytime Tel Mobile Number Email Address About Your Partner Surname Forenames National Insurance Number Daytime Tel Mobile Number Email Address Employment Details You Partner Employer Employer’s Address Average take home pay £ per week/month £ per week/month If you are self-employed please state your average earnings £ Are you in receipt of a state benefit? YES / NO (please circle one) Please state which benefit you are receiving Deductions can only be taken from Employment & Support Allowance, Income Support, Guarantee Pension Credit, Income-based Job Seeker's Allowance or Universal Credit Do you wish to come to an arrangement with Rushcliffe Borough Council? YES / NO (please circle one) Your offer is £ per week / month (please circle one) Please make a payment when you return this form. We will write to you to let you know if your offer has been accepted. Declaration By entering into this arrangement you are making a commitment to pay the balance of your account. Signed Date:
About Yourself. ID verification type ID verification type Official use only Have you previously enrolled on a course at Swindon College? Yes No ID Number: Unique Learner Number: Official use only Title (Mr/Mrs/Miss/Ms/Dr):
