Apply for Work Experience - St Michaels Hospice

Work Experience Request

About You

Name(Required)

First Name Last Name

Date of Birth(Required)

Phone(Required)

Email(Required)

Please supply your email address, as assigned by your school, college or university.

Enter Email Confirm Email

Current Place of Study

School, College or University Name(Required)

School, College or University Address

Address Line 1 Address Line 2 Town/City County Postcode Country

Course Tutor/Work Experience Co-ordinator's Name(Required)

Please ensure you have permission to share this information.

Course Tutor/Work Experience Co-ordinator's Email(Required)

Please ensure you have permission to share this information.

Availability

Please indicate your preferred dates for placement, and we will try our best to accommodate.

Start Date(Required)

End Date(Required)

Number of Days Requested(Required)

Please enter a number from 1 to 5.

Preferred Hours(Required)

The majority of work experience placements will take place between the hours of 09:00 and 16:00, however, we can be flexible to suit if transport requires.

Career Aspirations

Please answer the following questions. If your application is successful, this information will help us tailor your placement to your personal aims and objectives.

Please tell us why you are interested in a work experience placement at St Michael's Hospice(Required)

Please include details on the areas you’re most interested in, and how these will benefit your studies and career aspirations.

Health Declaration

We want to ensure that any placement offered is safe for you. Please disclose any health conditions or disabilities that may affect your ability to carry out key duties. Where possible, reasonable adjustments will be considered, and we may request further information to ensure the placement is suitable for you.

Do you have any health conditions or disabilities that we should be aware of to support you in this role?(Required)

Yes

If yes, please provide details below

Emergency Contact Details

Please provide the contact details of your emergency next of kin – ensuring you have gained permission to share their details.

Emergency Contact Name(Required)

First Name Last Name

Relationship to Yourself(Required)

Phone Number(Required)

Email(Required)