Cardiff Council - Unpaid Work Placement Request Form Thank you for your interest in an unpaid work placement with Cardiff Council. The aim of this form is to obtain enough information from you to create a placement that is both rewarding and informative for you, while also being of benefit to our organization. While we aim to support many people but sometimes it is not possible to match your request with our teams. We hope to be able to provide a response to your enquiry within 7 days. Please complete this form in full and return via email to workexperiencerequests@cardiff.gov.uk or by post to Cardiff Council Academy, Wilcox House, Dunleavy Drive, Cardiff, CF11 0BA Candidate Details Title (Mr, Miss, Mrs etc) First Name: Last Name: Home Telephone: Mobile Telephone: Email Address: Home Address: Postcode: Date Of Birth: Partner Organisations If you are attending a Organisation Name Name of Coordinator college, university, work based learning Address provider, or any other job , please provide the name Postcode and contact details of Telephone Number the organisation here Email Address Placement Duration and Working Times Please provide details of when you would like to commence a placement with us, the number of hours per day, and number of days per week. For example:- 5 hours per day, two days per week for a total of 2 months. Please note we will aim to accommodate your requirement in line with our business operations 4.C.412
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Oct 08
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Authorisation: Lynne David
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Background Information 1. Please tell us a little about yourself, such as your interests, any studies you have completed or are currently undertaking.
Placement Requirements 2. Please give an outline of your present occupation / skills / experience.
3. Please give specific details of the type of work placement you would like to undertake. What type of duties you would like to complete and what you hope to achieve from completing a placement with Cardiff Council
4.C.412
Issue 1
Oct 08
Process Owner: Lynne David
Authorisation: Lynne David
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UNPAID WORK PLACEMENT EQUAL OPPORTUNITIES MONITORING FORM Cardiff Council wants to deliver fair services, and to do so we need to find out who is using the services we offer. We would be grateful if you could take a couple of minutes to complete this form. It will help us improve our services, and we appreciate your help. All information will be held confidentially, and only used for monitoring the fairness of our services. We will not pass on your details to anyone else.
What is your name? What is your gender? Female Male Transgender
Bisexual
What is your age? Under 16 16 - 24 35 - 44 25 - 34 55 - 64 45 - 54 65+
What is your first language? English Welsh Other
Please …………………………
What is your sexual orientation? Gay Heterosexual Lesbian Other
specify
Prefer not to say
What is your ethnic group?
Asian or Asian British Bangladeshi Indian Pakistani Other Black or Black British African Caribbean Other
Chinese or Chinese British
Mixed Race White & Asian White & Black African White & Black Caribbean Other Mixed Background
White Welsh British European Other
Other Ethnic Group Prefer not to say
What is your religion?
Buddhist Christian
Hindu Jewish
Muslim Sikh
None Other Prefer not to say Please specify .................... Do you qualify as disabled?
The Disability Discrimination Act (1995) and updated by the Disability Discrimination Act (2005) defines a disabled person as someone with a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to day activities.
Yes No Prefer not to say If you identify as disabled, pleased advise us of the nature of any impairments that might require us to support you during your work experience (this information is essential to enable the relevant service area to undertake a suitable and sufficient assessment of risk presented to you during your placement).
4.C.412
Issue 1
Oct 08
Process Owner: Lynne David
Authorisation: Lynne David
Page 3 of 3