To book a course call NCA now on 01670 394441 or use the application form

COURSE APPLICATION FORM

To apply for any of the courses shown on this website please complete and submit the application form below and we will check to see if space is available on your requested course(s) and date(s). To ensure that we are meeting equal opportunities legislation all course applications are monitored. Under the terms of the Data Protection Act 1998, please note all training records are computerised. Full details are needed for our records. We are required to collect specific information for monitoring purposes.

1. LEARNING AND DEVELOPMENT EVENT DETAILS

Title of event:
Date(s): Date 1:
Date 2:
Date 3:
Start time:
Finish time:
Venue address:

2. APPLICANT DETAILS

Name in full:
(Mr/Mrs/Ms/Miss/Dr)
Job title
NCT payroll number
(if applicable):
Employing Organisation:
Workplace Address:
Workplace Telephone:
Email Address:
DDA 1995: Please indicate any special requirements you have to enable you to participate in the learning and development event – include any individual/dietary needs.

3. Applicant details: Where more than one application is being sent from your unit, please prioritise them. This will help if fewer places are available than requested.

Name Job title NHS/NCC payroll number (if applicable) or DOB Date of event Choice 1 Date of event Choice 2 Date of event Choice 3

Do any of the applicants listed below have any special requirements to enable them to participate in the learning & development event? (e.g. under DDA 1995) – Include any individual/dietary needs
Name Job title Special Requirments

4. APPROVAL - LINE MANAGER

Please comment on how this
event will support corporate/
team/individual objectives
Name of line manager:
Tel number of line manager:
Email address:

5. REASON FOR ATTENDANCE

Please indicate the rationale
for attending the event
How will this event support you?

6. EQUAL OPORTUNITIES MONITORING

Gender:
Age Group:
Disability:
Employment Pattern:
 
Ethnic Origin:
A. White:
 
B. Mixed:
C. Asian:
D. Black:
 
D. Chinese:
 

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