The Hoxton Trust
Horticultural Training Programme |
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Application form |
Please complete all sections before submitting. |
| Personal details |
Surname |
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Address |
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Date of birth |
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Telephone number |
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National Insurance number |
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Current clean driving license? |
yes
no
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Do you have a disability? |
yes
no
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Disability reference number |
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| Health |
Had you had a TETANUS injection in the last 10 years?
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yes
no |
Do you have any long term medical conditions?
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yes
no
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Are you taking any prescribed medicines?
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yes
no
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Are you receiving any medical attention or treatment?
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yes
no
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| Emergency contact |
Please can you give the name, address and telephone number of a friend or relative who can be contacted in the event of an emergency or accident. Please also give details of your doctor. |
Name |
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Address |
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Telephone number |
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Doctors` name |
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Address |
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Telephone number |
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| Education & qualifications |
Please list all schools and colleges attended and any courses completed or qualifications gained. |
Dates |
start
end |
School/College |
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Course |
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Qualifications |
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Dates |
start
end |
School/College |
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Course |
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Qualifications |
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Dates |
start
end |
School/College |
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Course |
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Qualifications |
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| Skills |
Please list your skills, which you may have learned from home, in previous employment, during work experience, or on other training courses (eg; gardening, cement mixing, bricklaying, typing, computer skills, painting and decorating etc.) |
Skill |
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Skill |
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Skill |
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Skill |
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Skill |
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Skill |
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| Work history |
Please give details of your last two periods of employment, starting with the most recent. |
| Dates | start
end |
Job title |
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Company |
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Responsibilities |
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Dates |
start
end |
Job title |
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Company |
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Responsibilities |
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| Additional experience |
Please indicate any other experience you have gained through voluntary work or community projects. |
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| Reasons for applying |
Why are you interested in a place on the Horticultural Training Programme and what do you hope to gain from the course? |
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| Declaration |
I declare that the information that I have given on this form is accurate and if that any of my circumstances change, which may affect my place on the course, I will advise Hoxton Trust immediately. |
Name |
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Date |
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EQUAL OPPORTUNITIES - The Hoxton Trust has an Equal Opportunity Policy.
This is available on request. |
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