On-line application form

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Work experience application form
Information will be treated in the strictest confidence by the line manager responsible for the placement.   
Please note work experience includes work shadowing and observation.
Personal details:
Please select your preferred work experience week  »
Please note if you are offered a work placement you will be expected to sign an Agreement for Unpaid work experience and comply with the terms of this Agreement.
Supporting information:
Equal opportunities policy: 
London North West University Healthcare NHS Trust commits itself to promoting equality of opportunity in all aspects of employment including work experience. 
The information you give will be treated in the strictest confidence and used for statistical purposes only.  It will in no way affect the consideration of your application for employment/work experience placement. 
Under the terms of the Disability Act 1995 a disability is defined as a 'physical or mental impairment which has a substantial long term effect on a person's ability to carry out normal day to day activities:

I certify that the information provided in this Application is complete, accurate and true in all respects.  »