Work experience referral form

For School-2. Fields marked with a star are required.

Who is completing this form?

I am theRequired

Student information

Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Year 13
Placement dates

Work placement information

MobileChoose the country code, then the number.
UK +44
Ireland +353
US/Canada +1
France +33
Germany +49
Spain +34
Portugal +351
Poland +48
Italy +39
Netherlands +31
Australia +61
India +91

Placement address

Yes
No

Placement details

Number of days, e.g. 5
Use a colon, e.g. 09:00-17:00

Employer's liability & public liability insurance

Information
All work placements must be vetted by Sirrond Ltd before they can be approved. Employer's Liability Insurance and Public Liability Insurance are legal requirements for work experience placements. Unfortunately, placements cannot proceed without the appropriate insurance cover.
Yes
No
Yes
No
Yes
No

Employer declaration

I can confirm that: the employer agrees to offer the placement to the named student; the information provided is accurate; the working environment is suitable and safe for a young person; appropriate supervision will be provided; and the employer may be contacted regarding future work experience opportunities.

Parent/guardian declaration

I can confirm that the named guardian gives permission for the named student to undertake this work experience placement.
Your details are shared with School-2 and Sirrond to arrange the placement, and deleted 12 months after submission.