Department of Engineering
Work Experience Placement Application
Date
APPLICANT INFORMATION
Name of Student
Date of Birth
School Year
Home Address
Phone number
Mobile number
Email Address
LEGAL STATUS
Do you have the
permanent right to
work in the UK – for
example as British or
EEA citizen)?
UK National Insurance
number (where held)
PARENT OR GUARDIAN
Name of Parent or
Guardian
Address if different from
above
Phone number
Mobile number
Email Address
MEDICAL CONDITIONS
Please note any Medical Conditions we may need to know about
SCHOOL
School Name
School Address
School Staff Contact Name
Phone number
Email Address
QUALIFICATIONS
Please give the total number of number of GCSE’S and A levels (or equivalents), if you have taken these exams
The total number of GCSEs (or equivalent) at Grade A* to C is
The total number of A Levels (or equivalent) at Grade A* to C is
Explain why you are interested in work experience in the Department of Engineering (Max 500 characters including spaces)
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
Student Name
Date
Signature
Parent or Guardian Name
Date
Parent or Guardian
Signature
PLEASE RETURN SIGNED COPY TO:
Mrs Barbara Paschalis, Divisional Administrator, Design & Technical Services, Cambridge University,
Department of Engineering, Trumpington Street, Cambridge, CB2 1PZ
Email: hr-office-t@eng.cam.ac.uk Telephone: +44 (0) 1223 332836