Learner Details:


 
 
 
Please note you will be unable to complete this application without attaching a form of current, valid identification.
If you have any questions or issues with this please contact the PTS Office 01252 712945

The name you supply will be used on any certificates and correspondence from Professional Training Solutions (PTS) Ltd, so please state your legal name, NOT a preferred name or nickname.


Title
First Name:
Surname:
Middle Name(s):
Known as / Preferred Name (if different from above):
Date of Birth:
Gender:
Email Address:
Mobile Tel No:
Address 1
Address 2
Address 3
Address 4
Post Code
National Insurance No:
Identification Documents
Identification Documents
Emergency Contact Details:
Contact Name:
Contact Number:
Relationship to you:
Contact Preference
Please select all allowed contact methods (you may select more than one option)



Please select your preferred contact method



Ethnic Group & Nationality:
Please select the appropriate nationality:
Please select the appropriate ethnicity:
Have you legally lived within the European Economic Area (EEA) for the duration of the last 3 years (for purposes other than full-time education)?
Please provide your date of entry to the EEA:
Are you currently seeking asylum in the UK?
Disability:
Please select the appropriate answer with regards to disability:
Other - Please give details
General Health:
Do you have any other illness or condition that we should be aware of?
If Yes, please give details:
Do you have any allergies that we should be aware of?
If Yes, please give details:
Do you suffer from depression or a similar nervous disorder?
If Yes, please give details:
Do you take any forms of medication?
If Yes, please give details:
Please note any additional information with regards to your health that is applicable to the course or your employer:
Do you consider yourself to have a Learning Difficulty?
If Yes, please give details:
Do you have an Education, Health & Care (EHC) plan?
Prior Qualifications:
For Government funding to support your learning, you must inform PTS Ltd of all your existing qualifications. Where you have no qualifications, please state NONE.
Please state qualifications in the following order: Subject - Level - Date Completed - Grade Eg. Maths - GCSE - 1999 - Grade C
PTS Qualification Details:
Level
Course Title
How will your training be funded?


Other (please specify)
Personal Statement:
Please detail below your reasons for wanting to undertake this course e.g – new job, promotion, new job role etc.
About your work and interests
Personal, Career & Progression Objectives 
Personal
Career/Progression:
What do you want to achieve in your career in the next 12 months?:
What are your aspirations in relation to career progression in the next 3 years?:
What are your interests and hobbies?
Employment Details Once Training has Commenced:
Please select the correct statement:



Do you have an in-date DBS check?



Self Employed:
I have been self-employed since:
Have you registered your self-employment with HM Revenue & Customs?
Employed
Hours worked per week:
Length of Employment
Please give a copy of your contract to your assessor on your first / next meeting 
Organisation Name
Address
Postcode
Manager Contact Name (if applicable)
Manager Contact Email
Manager Contact Number
Approx number of employees

Unemployed
Please state the length of unemployment (months)

Voluntary
Please state the length since last paid employment (months)

Hours volunteered per week
Please confirm that you do not receive payment for this work other than expenses incurred
Organisation Name
Organisation Address
Postcode
Organisation Contact Email
Organisation Contact Number
Approx number of employees

Benefits:
Please confirm whether you are in receipt of any of the following:
Other State Benefit (please specify)
Please confirm that your above selection or absence of selection of the above choice(s) is correct and that you can provide evidence if required.
Declaration Statements:
I give permission for PTS to obtain my Unique Learner Reference Number and obtain my prior qualifications via MIAP (A National Government Service)
Are you currently in any other Government funded training?
If Yes, please give details:
GDPR & Data Protection Act 2018
The information that you provide will be passed to Education Skills Funding Agency (ESFA). The ESFA is responsible for funding, planning and encouraging education and training for young people and adults in England, and is registered under GDPR and The Data Protection Act 2018. The information you provide will be shared with other organisations for the purpose of administration, careers and other guidance, and statistical and research purposes. It will also be shared with other organisations who are funding this project. At no time will your personal information be passed onto organisations for sales and marketing purposes.
Learner Declaration:
By selecting Agree below, you confirm that all information presented on this form is correct. You also understand that, should the information that you have provided be found to be false, that PTS Ltd may take the necessary steps against you to recover all tuition fees and any other costs associated with your learning. You also agree to abide by our terms and conditions which can be found below
Terms and Conditions  https://www.protrain-solutions.co.uk/ 
Please ensure you click the submit button at the bottom after signing the declaration 
Household Situation
Please tick which of the following statements apply (one or more may apply):




 
 
Signatures
Printed Name Signature Date Options
Applicant Obtain Signature