Animal care Work placement

Title *

First Name *

Last Name *

Date of Birth *

00/00/0000

Age *

Address *

Address Line 1

Address Line 2

City

Zip / Postal Code

Phone *

Email *

Next of kin *

Relationship to you? *

Next of Kin Contact Number * *

Do you suffer from any illness or condition (including mental health conditions) that we should be aware of?

Yes
No

If yes, please give details

Are you up to date with Tetanus immunisation?

Yes
No

If the answer is no, would you please make arrangements with your GP to be immunised before commencing work with us. If you suffer from asthma, have a bronchial complaint, or are in any way allergic to animals (fur, feathers etc.), you may wish to consult your GP before considering an application for voluntary work with us..

Please list previous work experience (if any) and any experience working with animals (domestic or wild animals)

Name Of College *

Name Of Tutor *

Tutor Contact Number * *

Please tell us any previous work experience placements achieved

Please give current dates available *

Please indicate below your availability

The rescue is in a rural location and approximately 10 min from the nearest bus stop. Please detail below your transport arrangements *

The rescue is in Laughton en le Morthen, Sheffield (S25)

What made you choose to apply to our rescue? *

I confirm that all information given is accurate and truthful

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Before commencing work you will be given induction and Health & Safety notes that we require you to acknowledge having read by signing a copy. Do you agree to this?

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Animal care Work placement

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