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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
Select...
Mr
Miss
Mrs
Ms
Dr
First Name:
Surname:
Middle Name(s):
Known as / Preferred Name (if different from above):
Date of Birth:
Gender:
Select...
Male
Female
Prefer not to say
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)
Email
Text Message
Post
Telephone
Please select your preferred contact method
Email
Text Message
Post
Telephone
Ethnic Group & Nationality:
Please select the appropriate ethnic group:
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White - British
White - Irish
White - Other
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Other
Chinese
Asian or Asian Black - Indian
Asian or Asian Black - Pakistani
Asian or Asian Black - Bangladeshi
Asian or Asian Black - Other
Mixed - White & Black Caribbean
Mixed - White & Black African
Mixed- White & Asian
Mixed - Other
Other / Prefer not to say
Please select the appropriate nationality:
Select...
GB - United Kingdom
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)?
Select...
Yes
No
Please provide your date of entry to the EEA:
Are you currently seeking asylum in the UK?
Yes
No
Disability:
Please select the appropriate answer with regards to disability:
Select...
N/A
Physical Disability
Hearing Impairment
Visual Impairment
Learning Difficulty
Other
Other - Please give details
General Health:
Do you have any other illness or condition that we should be aware of?
Yes
No
If Yes, please give details:
Do you have any allergies that we should be aware of?
Yes
No
If Yes, please give details:
Do you suffer from depression or a similar nervous disorder?
Yes
No
If Yes, please give details:
Do you take any forms of medication?
Yes
No
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?
Yes
No
If Yes, please give details:
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
Select...
Level 2
Level 3
Level 4
Level 5
Course Title
How will your training be funded?
16 - 18 Fully Funded Apprenticeship
Paid for by yourself or your workplace
19+ Part Funded Apprenticeship
Not Known / Not Applicable
Advanced Learning Loan
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.
Employment Details Once Training has Commenced:
Please select the correct statement:
I am self-employed.
I am in paid employment (inc. apprenticeships)
I am a volunteer.
I am unemployed.
Do you have an in-date DBS check?
Yes
No
N/A
Self Employed:
I have been self-employed since:
Have you registered your self-employment with HM Revenue & Customs?
Select...
Yes
No
Employed
Hours worked per week:
Less than 16 (Not eligible for Apprenticeship funding)
16-29
30+
Length of Employment
Learner has been employed for upto 3 months
Learner employed for upto 4 to 6 months
Learner has been employed for upto 7 to 12 months
Learner has been employed for more than 12 months
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
Less than 10
51 - 250
1001+
11 - 50
251 - 1000
Don't Know
Unemployed
Please state the length of unemployment (months)
0-6
12-23
36+
6-11
24-35
N/A
Voluntary
Please state the length since last paid employment (months)
0-6
12-23
36+
6-11
24-35
N/A
Hours volunteered per week
Less then 16
16-19
20+
Please confirm that you do not receive payment for this work other than expenses incurred
Select...
Yes
No
Organisation Name
Organisation Address
Postcode
Organisation Contact Email
Organisation Contact Number
Approx number of employees
Less than 10
51-250
1001+
11-50
251-1000
Benefits:
Please confirm whether you are in receipt of any of the following:
Select...
Job Seekers' Allowance (JSA)
Employment & Support Allowance - Work Related Activity Group (ESA WRAG)
Universal Credit
Other State Benefit (please specify)
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.
Select...
Confirm
Deny
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)
Yes
No
Are you currently in any other Government funded training?
Yes
No
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.
Select...
I agree
I do not agree
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
Select...
I agree
I do not agree
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):
No household member (including myself) is in employment, and the household includes one or more dependent children
No household member (including myself) is in employment, and the household does not include dependent children
I live in a single adult household with one or more dependent children (aged 0-17 years or 18-24 years if full time student)
None of the statements 1-3 apply
I confirm that I wish to withhold this information
Sign Form
Click the Confirm button to sign the form
Signatures
Printed Name
Signature
Date
Options
Applicant
Obtain Signature