APPLICATION FOR POSITION OF TRAINEE

PLEASE COMPLETE PAGES 1-5.

DATE __________________________

Name ______________________________________________________________________________

Present address ______________________________________________________________________

How long  have you lived at this address    

Telephone (           )              

Hours  desired            qFULL-TIME ONLY             qPART-TIME ONLY            qFULL- OR PART-TIME

If Part-Time, please state when you are available for work?__________________________________

____________________________________________________________________________________

QUALIFICATIONS

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing address)

NUMBER OF YEARS COMPLETED

QUALIFICATION GAINED

High School

College

Other

Please list two references

Name ________________________________   Name _____________________________

Position _____________________________

Position_______________________________

Company ____________________________

Company _____________________________

Address _____________________________

Address ______________________________

            ______________________________

             _______________________________

Telephone  (      )                                            

Telephone ____________________________

An application form sometimes makes it difficult for an individual to adequately summarize a complete background.  Use the space below to summarise any additional information necessary to describe both yourself and why you are applying for the position of trainee within the Pitstop Cafe (Additional sheet attached if required).

Work experience

Please list any work experience that you have gained prior to applying for the position of trainee within the Pitstop Café.

Name of employer/training provider
Address

Name of last supervisor

Employment dates

Voluntary/

Paid position

Phone number

From

To

Voluntary

Paid

Your last job title

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer/training provider
Address

Name of last supervisor

Employment dates

Voluntary/

Paid position

Phone number

From

To

Voluntary

Paid

Your last job title

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Medical Information

Please state any medical conditions and medication required (Additional Information Sheet attached if required)

Doctor ___________________________________  Telephone Number _______________________

Medical Practice  ___________________________________________________________________________________

Social Worker____________________________________________________________________________

Address  __________________________________________________________________________________

Telephone Number  __________________________________________________________________________________

Emergency Contacts:

Name  __________________________        Name  _________________________________________

Relationship   ____________________ Relationship ________________________________________

Contact Number ___________Contact Number  _________________________________________

Did you complete this application yourself   q Yes q No

If not, who assisted you? ______________________________________________________________

Signature of applicant__________________________________________ Date: ___________________

The Pennypit Special Needs Youth Club is an equal employment opportunity employer.  We adhere to a policy of making employment decisions without regard to race, colour, religion, sex, sexual orientation, national origin, citizenship, age or disability. 

                Thank you for completing this application form and for your interest in the Pit Stop Cafe.    All completed applications should be returned to;

Manager

Pennypit Special Needs Youth Club/ Pitstop Café

Pennypit Centre

Rope Walk

PRESTONPANS

EH32 9BN