APPLICATION FORM EUROPEAN TRAINING SERVICES LIMITED

How did you hear about the programme? Please specify: College/University If yes, please specify:............. University Careers Services If yes, please specify:.......... On-line graduate recruitment sites: If yes, please specify:.......... Through a friend Other:................................................................... 1. 2. 3. For which destination country(ies) are you applying? 1. 2.

In which sector of activity would you like to receive your training?

PERSONAL DETAILS
Christian name: Preferred title: Mr/Mrs/Miss/Ms Address: Surname: Male/Female: Home telephone No: Work telephone No: Date of Birth: Post code: Mobile: E-mail: Nationality: Marital status: No. of dependants:

EDUCATION AND TRAINING

General education Name of school: Subjects Exam taken Grade

Further education Name of College/University:

Subjects

Exam taken

Grade

LANGUAGE SKILLS
Knowledge of foreign languages Language: Proficiency: Speaking: basic, average, good, fluent Understanding:

Please provide an-up-to date CV listing your present and past employment details, and send it along with this application form. Please provide an-up-to date CV listing your present and past employment details, and send it along with this application form.

EMPLOYMENT EMPLOYMENT

Have you recently had or have you ever suffered any illness or medical condition? Have you recently had or have you ever suffered any illness or medical condition? Yes No Yes If yes, please tick the appropriate: If yes, please tick the appropriate: Fits or fainting attacks trouble Stomach Fits or fainting attacks Chronic or recurrent cough Stomach trouble Hernia Chronic or recurrent cough or physical impairment Injury Hernia Rheumatism Injury or physical impairment trouble Skin Rheumatism No Eyesight problems blindness Colour Eyesight problems Deafness Colour blindness Dyslexia Deafness trouble Kidney Dyslexia Heart trouble Kidney trouble Depression Heart trouble

MEDICAL (the following section must be completed) MEDICAL (the following section must be completed)

Nervous trouble Asthma Nervous trouble Vertigo Asthma Diabetes Vertigo trouble Back Diabetes Musculo-skeletal trouble Back trouble Other (specify below) Musculo-skeletal trouble

Skin trouble Depression Other (specify below) Are you currently, or within the last 12 months, taking any medication? If yes, please specify Are you currently, or within the last 12 months, taking any medication? If yes, please specify

Do you smoke? Do any allergies to: Do you you have smoke? Do you have any allergies to:

ADDITIONAL INFORMATION ADDITIONAL INFORMATION

Dust? Feathers? Dust? Cats/Dogs/other animals? Feathers? Pollen? Cats/Dogs/other animals? Others? Pollen? Others?

Yes/No Yes/No

Do you eat the following? Do you eat the following? Meat? Fish? Meat? Eggs? Fish? Cheese? Eggs? Is there any food you do not eat? Cheese? Is there any food you do not eat?

Yes/No Yes/No

HOBBIES/INTERESTS/OTHER EXPERIENCE (Voluntary, vocational, etc.) HOBBIES/INTERESTS/OTHER EXPERIENCE (Voluntary, vocational, etc.)

I certify that the information I have given is true and correct. I understand that any false statement may invalidate my application. I certify that the information I have given is true and correct. I understand that any false statement may invalidate my application. Date: . Signature: . Date: .

DECLARATION DECLARATION

Please return completed forms to: European Training Services, Staffordshire University Business Village, The Friary, Lichfield WS13 6QG. Tel 01543 308636 / 37 Fax 01543 308625

Signature: .