Student Details

















Employer Details







Please download and read the Work Placement Agreement below:

Work Placment Agreement

Student Agreement:
As the student named above I agree to take part in this work experience scheme and confirm that I have read and understood both sides of this form. I also agree to hold in confidence any information about the Employer’s business which I may obtain during this work period and not to disclose any such information to another person without the Employer’s permission. I also agree to observe all safety, security and other regulations laid down by the Employer and made known to me either by the Employer’s representatives or by displayed instructions.

Please make sure you change the date to todays date!


Please ensure that the date is in the format dd-mm-yy other seperators will not work! e.g 01.01.19

I accept the agreement.

Parent Agreement:
As parent/guardian of the student named above I confirm that I have read and understood both sides of this form and agree to his/her taking part in this scheme and undertake that he/she will observe the conditions set out. I have read and understood the information about data protection and agree to abide by the elements stated. In the interest of my child I confirm that:

Does the student above suffer from any medical conditions?

I accept the agreement.

Please make sure you change the date to todays date!


Please ensure that the date is in the format dd-mm-yy other seperators will not work! e.g 01.01.19

Disclaimer: Please ensure the information is correct before submitting it. YOU WILL NOT BE ABLE TO CHANGE IT LATER.