Alpha Development Apprenticeship Qualification Registration Form Personal Information Unique Learner Number (ULN) if known __ __ __ __ __ __ __ __ __ __ First name __________________________________________ Surname ________________________________________ Middle name ______________________________________ Any previous surnames __________________________ Email
Work _______________________________ Personal _________________________________________
Mobile Number Work _______________________________ Personal_________________________________________ Address_______________________________________________________________________________________________ _____________________________________________________ Postcode _______________________________________ Date of birth_________________________________________ N.I number ______________________________________ Gender _____________________________________________ What is your ethnic group? White
Mixed
☐ English/Welsh/Scottish/Northern Irish/British ☐ Irish ☐ Other ____________________________________________
☐ White and Black Caribbean ☐ White and Black African ☐ White and Asian ☐ Other _____________________________________________
Asian ☐ Indian ☐ Pakistani ☐ Bangladeshi ☐ Chinese ☐ Other _____________________________________________
Black ☐ African ☐ Caribbean ☐ Other ______________________________________________
Other ethnic group ☐ Arab ☐ Other ____________________________________________
Identity/Residency Document provided (i.e. passport, EU Citizen ID Card, Birth Certificate, UK Border Agency Documents…) ________________________________________________________________________________ Name of emergency contact __________________________________ Relationship __________________________ Emergency phone number __________________________
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Your Employment Company name
_________________________________________________________________________________
Company address ____________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Job title _______________________________________________________________________________________________ Department_________________________________________________________________ Contracted hours per week ___________________________
Years in current role _________________________
Your Manager Manager’s name _____________________________________________________________________________________ Manager’s job title ____________________________________________________________________________________ Manager’s email _____________________________________________________________________________________ Manager’s contact phone number _________________________________________________
Apprenticeship Eligibility (only answer if you are registering for an apprenticeship) Will you be enrolled on another apprenticeship, or another Department for Education (DfE) funded Further Education/Higher Education programme, at the same time as any new apprenticeship you start?
☐ Yes ☐ No
Do you have the right to work in England?
☐ Yes ☐ No
Does your employment contract last beyond the expected end date of your study
☐ Yes ☐ No
Are you paid at least a wage consistent with the law for both the time you are in work and in off-the-job learning?
☐ Yes ☐ No
Do you spend at least 50% of your working hours in England?
☐ Yes ☐ No
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Do you confirm that you have discussed this application with your line manager, and they are aware that the apprenticeship must be completed in contracted working hours and 20% off the job training must be provided?
☐ Yes ☐ No
Do you confirm that the apprenticeship will equip you with new knowledge skills and behaviours as specified in the apprenticeship standard?
☐ Yes ☐ No
Qualifications Alpha Development are responsible for checking the eligibility of all individuals and ensuring that they are on the most appropriate programme for their career development. This involves ensuring we have evidence of prior learning, that the programme selected is at the appropriate level in relation to any prior learning and it relates to the individual’s job role. We also check prior learning to assess whether you are eligible for exemptions on the programme you have selected. What is the subject and level of the highest qualification you hold? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Do you have any qualifications which overlap with the subject area of the apprenticeship? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ List your highest English qualification _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ List your highest Maths qualification _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
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Citizenship/Residency (Tick the box that applies) ☐ I am a citizen of a country within EU or European Economic Area (EEA) or have the right to abode in the UK and have been ordinarily resident in the EEA for at least the previous three years on the first day of learning? I am a non EEA citizen with permission from the UK government to live in the UK and have been ordinarily resident in the UK for at least the previous 3 years before the start of learning
☐
A member of Armed Forces and Royal Fleet personnel with discretionary, exceptional or indefinite leave to enter or remain
☐
I have a husband, wife, civil partner and child of any of the above
☐
Additional Support Please advise if, at the start of the course, you are: Aged between 16 and 18 years old, at the start of the course and have not been in the care of your local authority
☐
Aged between 16 and 18 years old, at the start of the course and have been in the care of your local authority
☐
Aged between 19 and 24 years old and have either an Education Health and Care (EHC) plan provided by your local authority or have been in the care of your local authority.
☐
Aged 19+ and have not been in the care of your local authority/do not have an EHC plan provided by your local authority
☐
Do you have a learning difficulty, disability or health problem?
☐ Yes ☐ No ☐ Prefer not to say
If yes, please give details:
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We welcome applications from learners with learning difficulties and disabilities. We encourage you to disclose any learning difficulty or disability. We will contact you for a confidential conversation to see how we can assist or support you. We will never share this information with your employer without your consent. For the purposes of relevant data protection legislation GDPR, the DfE is the data controller for personal data processed by the ESFA. Your personal information is used by the DfE to exercise its functions and to meet its statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009 and to create and maintain a unique learner number (ULN) and a personal learning record (PLR). Alpha Development will use your personal information to fulfil its obligations to deliver the apprenticeship or qualification for which you are registered. This may involve sharing your information with awarding organisations for the purpose of recording your progress and completion of any qualifications. Your information will be securely destroyed after it is no longer required for these purposes. Your information may be shared with third parties for education, training, employment and well-being related purposes, including for research. This will only take place where the law allows it and the sharing is in compliance with data protection legislation. The English European Social Fund (ESF) Managing Authority (or agents acting on its behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training. Please use the space below to let us know any other relevant information in relation to your course of study:
Signature
Signed: ______________________________________________________ Date: _________________________________
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For Alpha Development Use ▪ Unique Learner Number (ULN)
__ __ __ __ __ __ __ __ __ __
▪ Application form o
Date sent
_______________________________
o
Date returned
_______________________________
▪ English certificate received and checked
☐
▪ Maths certificate received and checked
☐
▪ Initial assessment completed if applicable: o
Maths
Date: ___________________
Result: ____________________
o
English
Date: ___________________
Result: ____________________ ☐
▪ Copy or I.D received and uploaded ▪ Commitment statement signed and dated by learner, manager and Alpha
☐
▪ Agreement signed and dated by learner and manager
☐
▪ First day or learning/skills scan on the system and dated the same date as the start date on the agreement and commitment statement
☐
▪ Register learner with the relevant awarding organisation: o
Deadline date to be registered
☐
o
Date registered
☐
o
Confirm accuracy of details on system
☐
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Employer / Location Health and Safety Assessment Record Employer Details Date of Assessment Employer's name
Number of employees
Nature of business Workplace address
Main contact (Name & Tel No) Health and safety contact
Learner(s) name(s) Supervisor(s) name(s) Type of work carried out at workplace location Enforcement action (Prosecutions, Notices) Health and safety committee / safety representation
Health & Safety Procurement Standard 1 A
B
C D
Health and Safety Policy Is there a clear commitment to health, safety & welfare (written policy statement mandatory when 5 or more employees? Are the responsibilities for health and safety clearly stated (must be recorded when 5 or more employees? Are arrangements for health and safety clearly stated recorded when 5 or more employees? How are the commitment, responsibilities and arrangements for health & safety (in 1A -1C above) communicated to employees?
Assessment of Standard 1
Yes/ No
Met
1
Evidence/ Comments
☐
Part Met
☐
Not Met
☐
2 A
Risk assessment and control Have risk assessments been carried out and significant risks identified? (including COSHH) B Have the significant findings and details of any groups identified as being especially at risk been recorded (mandatory where 5 or more employees? C Have control measures been identified and put in place as a result of the risk assessments? D Do the risk assessments take into account young persons, including giving consideration to their age, inexperience, immaturity and lack of awareness of risks? E Give details of the risks and control measures relating to the occupations and the specific activities carried out in the workplace. F How are the risks and control measures explained to employees and others? Assessment of Standard 2
Yes/ No
Met
3 A
Accident, incidents and first aid Have adequate arrangements for first aid materials been made? B Have adequate arrangements for trained first aid persons been made? C Are accidents and first aid treatment rendered recorded? D Are or will all legally reportable accidents, incidents and ill-health be reported to the enforcing authority and the Learning and Skills Council and will they be investigated (including RIDDOR reportable accidents incidents? E How are the arrangements for accidents, incidents, ill-health and first aid made known to all employees? Assessment of Standard 3
Yes/ No
Evidence/ Comments
☐
Part Met
☐
Not Met
☐
Evidence/ Comments
Induction training and regular updates
Met
2
☐
Part Met
☐
Not Met
☐
4 A B
Supervision, training, information and instruction Are employees provided with adequate competent supervision? Is initial health and safety information, instruction and training given to all new employees on recruitment?
Yes/ No
Is ongoing health and safety information, instruction and training provided to all employees? D Is health and safety information, instruction and training recorded? E How is the effectiveness of health and safety information, instruction and training assessed, and is the assessment recorded? Assessment of Standard 4
Evidence/ Comments
C
5 A B
Met
Work equipment and machinery Is correct machinery and equipment provided to the appropriate standards? Is equipment adequately maintained?
C
Are guards and control measures in place as determined through risk assessment?
D
Are safe electrical systems and equipment provided and maintained?
Yes/ No
Assessment of Standard 5
6 A
B C D
Met
Personal protective equipment and clothing Is PPE/C provided, free of charge, to employees as determined through risk assessment? Is training and information on the safe use of PPE/C provided to all employees?
Yes/ No
☐
Part Met
☐
Not Met
☐
☐
Not Met
☐
☐
Not Met
☐
Evidence/ Comments
☐
Part Met
Evidence/ Comments
Is the proper use and storage of PPE/C enforced? Is PPE/C maintained and replaced?
Assessment of Standard 6
Met
3
☐
Part Met
7 A B C D E
F
Fire and emergencies Is there a means of raising the alarm and fire detection in place? Are there appropriate means of fighting fire in place? Are effective means of escape in place including unobstructed routes and exits? Is there a named person(s) for emergencies?
Yes/ No
Is fire-fighting equipment, preventive measures and emergency arrangements maintained, including through tests and practise drills? Is a fire log/record book kept?
Assessment of Standard 7
8 A
B
Evidence/ Comments
Met
Safe and healthy working environment Are premises (structure, fabric, fixtures and fittings) safe and healthy (suitable, maintained and kept clean)? Is the working environment (temperature, lighting, space, ventilation, noise) an appropriate safe and healthy one?
Yes/ No
Are welfare facilities (toilets, washing, drinking, eating, changing) provided as appropriate and maintained? Assessment of Standard 8
☐
Part Met
☐
Not Met
☐
☐
Not Met
☐
Evidence/ Comments
C
9 A
B
C D E F
Met
General health and safety management How does the employer consult and communicate with employees and allow them to participate in health and safety? Does the employer provide medical / health screening as appropriate and any required medical / health surveillance?
Yes/ No
Does the employer have access to competent health and safe advice and assistance? Does the employer review health and safety annually? Does the employer display the necessary signs and notices? Is employer’s liability insurance current and other insurance in place as appropriate to the business undertaking?
☐
Part Met
Evidence/ Comments
Insurer's name: Policy number: Expiry date: Insurer informed of learners? Yes / No / N/A
G
How does the employer assess, review and update employees' capabilities? H How does the employer manage employees' work when it is away from the employer's own premises or when employees are placed with another employer/site? Assessment of Standard 9
Met
4
☐
Part Met
☐
Not Met
☐
Recommendation
Accept
☐
Certificate of Assessment Issued?
Yes
☐
Risk Category
High
☐
Accept with Action Plan ☐
Reject
☐
Low
☐
☐
No
Medium
☐
The employer or their representative: (please sign to agree that this is an accurate record of the assessment) Signed:
Print name:
Job title:
Date:
Alpha Development Details: Assessment undertaken by: Name:
Job title:
Quality checked by: Name:
Job title:
Date:
Date:
Assessment Type: Initial assessment ☐
Re-assessment ☐
Other (please specify):
5
Date of next assessment:
Action Plan Ref
Action required
By who
Action plan prepared by: Agreed by: Signed:
Dated:
Action plan review dates:
6
Target date
Completed (signed off)
10
Management of learner's/ young person's health and safety A Has the employer assessed the risks to the learner / young person taking into account their age, inexperience, immaturity and lack of awareness of risks? B Have the assessments taken into account any other special needs or circumstances including any disability and/or medical/health condition? C Has the employer put in place control measures for learner / young person as a result of the assessments and have they informed the learner and their supervisor(s)? D Detail any necessary prohibitions and restrictions identified by the risk assessments that apply to the learner/young person. E Does the employer provide competent supervision for learners / young persons and do they have a designated person to take overall responsibility for them? F Does the employer provide an induction and ongoing information, instruction and training to learners / young persons reflecting the findings of the risk assessment, working environment, work activities age, experience and any special needs? G Does the employer provide, free of charge, any necessary personal protective equipment and clothing (as determined by the risk assessment) and ensure its proper and effective use? Assessment of Standard 10
Yes/ No
Evidence/ Comments
Supervisor(s) name(s):
Met
�
Part Met
�
Not Met
�
Action Plan Ref
Action required
By who
Action plan prepared by: Agreed by: Signed:
Dated:
Action plan review dates:
7
Target date
Completed (signed off)
Standard 11 – to be completed for all sub -contracted provision 11 A B
C
D E
Providers' Health & Safety Audits of Employers/Placements Does the Provider carry out Health & Safety Audits on Employers/Placements? Are the appropriate Provider staff occupationally competent to assess the H&S in the particular sector? Is the H&S audit paperwork/form suitable for the occupational sector in which the provider delivers? Are there any particular risks that have been noted? Are specific control measures required?
Yes/ No
Does the Provider allocate any Risk Rating system to Employers/Placements/Occupations? G Does the Provider agree Action Plans with Employers/Placements to correct any concerns? H Does the provider carry out re-assessments that ensures improvement actions are implemented? If so, how frequently? Assessment of Standard 11
Evidence/ Comments
F
Met
☐
Part Met
☐
Not Met
☐
Action Plan Ref
Action required
By who
Action plan prepared by: Agreed by: Signed:
Dated:
Action plan review dates:
8
Target date
Completed (signed off)
12 A B
Other Policies Does the Organisation have a Child Protection Policy? Has Child Protection training been carried out within the organisation?
Yes/ No
Have all staff who have regular contact with learners been subjected to the appropriate a CRB Check (Enhanced or Standard), and is a record maintained of these checks? D Does the Organisation have a Safeguarding Policy? E Does the Organisation have measures in place to protect Vulnerable Adults F Does the Organisation have an Equal Opportunities Policy and Procedures that include targets for improving participation and achievement by minority groups? G Does the Organisation have Data Protection Policy/Procedures and adequate measure to ensure data security? H Is the Organisation compliant with the Disability Discrimination Acts 1995/2005? I Is there evidence that the Organisation has made 'reasonable adjustments' for disabled persons J Are the premises reasonably accessible for disabled persons? Assessment of Standard 11
Evidence/ Comments
C
Met
☐
Part Met
☐
Not Met
☐
Action Plan Ref
Action required
By who
Action plan prepared by: Agreed by: Signed:
Dated:
Action plan review dates:
9
Target date
Completed (signed off)