Stirling Council - Work Placement Programme Form

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Thank you for agreeing to host a young person for a work placement. This form should take between 5-10 minutes to complete. Please note that you will be required to submit details of your organisation’s employers liability insurance if applicable, therefore we advise that you have these to hand before starting the form.

Please note: If you are hosting more than one young person, or have already completed a form for this placement in the last 6 months, there is no need to complete the form again. Please email details of additional pupil’s requests to stirwex@ceg.org.uk

If you have any queries or questions about the programme or the completion of this form, please contact the work placement services team on 0141 270 6116 or email stirwex@ceg.org.uk

Email *

Young Person's Name *

Please select the school the young person attends *

Employer details –

The name and address of the organisation and where the young person will be based.

Name of Organisation *

Number of Employees *

Organisations Address *

Town *

Postcode *

Placement Supervisor *

This will be who will supervise the young person whilst on placement

Job Title *

Telephone Number *

Mobile Number

Have you hosted this work placement in the last 12 months? *

Please note: If you are hosting more than one young person, or have already completed a form for this placement in the last 6 months, there is no need to complete the form again. Please email details of additional young person’s requests to stirwex@ceg.org.uk

Yes

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