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PLEASE READ CAREFULLY BEFORE STARTING YOUR APPLICATION: Leeds Teaching Hospitals NHS Trust operates an equal opportunities work experience programme and we try our utmost to place all of our applicants in positions related to their specific interests. Should you have any trouble filling in this form, our staff at the NHS Employment Advice Centre will be more than happy to help.

Throughout this application you will be asked to tick boxes to demonstrate that you have read and understood all of the information. Only applications that have all FOUR boxes ticked will be accepted. Any incomplete applications cannot and will not be processed.

PLEASE NOTE: We make no guarantee that a suitable placement will be found and completion of this application form is by no means an indication that a placement has been or will be made on your behalf. Candidates are warned against assuming that they have a placement just because they have applied and we recommend investigating other employers as well as just the Leeds Teaching Hospitals NHS Trust.

Due to the high demand for placements, we can only offer one-week placements in clinical areas and no exceptions to this rule can be made. Due to the nature of medical school applications, applicants are now expected to have completed at least one weeks work experience in a hospital environment prior to being accepted for a university place. With this in mind placement priority is now given to students in Year 12. Candidates must be aged at least 15 to observe in non-clinical, administrative areas and in the final term of Year 11 or above to observe in clinical areas. However students should be aware that The Leeds Teaching Hospitals NHS Trust are only able to offer one placement per student, so we advise choosing the location and time of your placement request wisely.

As applications can take up to 90 days to process, you must apply at least 90 days before you wish your placement to start. Late applications are unlikely to be succesful. Please be aware that we will contact you if a suitable placement can be found and we will also notify you if your application has been unsuccessful. Please do not ring our offices to check on your applications progress as it ties up our resources and slows down the process further still. If necessary the team can be reached at WorkExperience@leedsth.nhs.uk but please allow plenty of time for us to respond.

Welcome to your application for work experience with the Leeds Teaching Hospitals NHS Trust. Please remember that the reference for your application will be your name, and date of birth, you will not need to make a note of any other numbers during the application process. You should use your full name and quote your date of birth in any other correspondance with us so that we can quickly locate your file.

You are about to apply online using a HTML coded form. A HTML form cannot be downloaded or saved locally before submitting. It is designed to gather some important details so that we can ensure you meet the criteria of your chosen work experience placement and make sure that you accept the terms and conditions of the placement. By filling out and submitting this form, you acknowledge that a record of your personal information will be held by the Education Liaison Team. We inturn will protect this information under the terms of the Data Protection Act 1998 and the Trusts internal Misuse of Information Policy.

 

SECTION 1: Personal Details

Surname: ......................

Forenames: ..................

Preferred title (Mr/Ms): ..

Address: .......................

......................................

Postal town: ..................

Postcode: .....................

Telephone (home): .......

Telephone (mobile): .....

Date of birth: ................

Email address: .............

We will mostly use email to contact you so the email address that you choose to use should be current and valid. Please retype the same address below to ensure accuracy.

Retype email address: .

 

SECTION 2: Work Placement Details

This placement is only available in Leeds. This means that you will be responsible for organising your own accomodation if needed, travel arrangements and any other cost incurred in taking up the placement if your application is succesful. We reserve the right to arrange placements at any of the Trust's six hospital sites (please see our website), however it is most likely that placements will take place at either The Leeds General Infirmary or St James's University Hospital.

What area would you like a work experience placement in (please tick one only):

............. Other (Please State)

Which department are you interested in (please note we cannot accept applications for placements in the A&E department)?

In this section you will be asked how many days you want your placement to last, please remember that clinical placements can only last a maximum of 5 days. You will then be given the opportunity to input the three sets of dates that you are available for the placement to take place between. We will always endeavour to arrange your placement during your first choice but when necessary your subsequent choices will be used. Students that fail to turn up for placements arranged for dates that were specified on their application will be unable to reapply for the programme unless the circumstances are deemed exceptional by the Education Liaison Manager and sufficient notification has been given.

How many days would you like your placement to last for? ....... days (Max. 5)

Optional Placement Dates

1. Start: Finish:

2. Start: Finish:

3. Start: Finish:

 

SECTION 3: School & Education Details

Name of school/college/university: ........

If still in school, which year are you in?..

Address: .......................

......................................

Postal town: ..................

Postcode: .....................

Telephone: ...................

My GCSE or equivalent grades:

Please specify if these results are OR

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

Subject: Type (e.g. GCSE/NVQ): Grade:

 

My A-Level or equivalent grades (fill in if applicable):

Please specify if these results are OR

Subject: Type (e.g. A/AS/BTEC): Grade:

Subject: Type (e.g. A/AS/BTEC): Grade:

Subject: Type (e.g. A/AS/BTEC): Grade:

Subject: Type (e.g. A/AS/BTEC): Grade:

Subject: Type (e.g. A/AS/BTEC): Grade:

Subject: Type (e.g. A/AS/BTEC): Grade:

 

My higher education degree or equivalent grade (fill in if applicable):

Please specify if these results are OR

Subject: Type (e.g. BA/MA/MSc): Grade:

In 500 words or less please give details of any interests or activities that you feel may support your application. Please include details of what you hope to achieve through undertaking this work experience.

1. Do you accept the Terms & Conditions of the programme as outlined in the text above?

2. Do you confirm that you understand that any cost incurred from undertaking a placement will not be refunded by the Leeds Teaching Hospitals NHS Trust and that the location of the placement could be at any of the six hospitals located in the Leeds area? .

3. Do you confirm that you understand the date selection process for placements and that failure to turn up on the specified dates, without sufficient reason, will result in the loss of your placement?

4. Do you confirm that all of the information that you have entered on this application is true and that durring your placement you will abide by Trust policies on confidentiality and behaviour in the workplace?

Thank you for taking the time to complete this application. When you are ready please feel free to click the submit button to send it through to us.  If you would like to print a copy for your own records first, please click here.