Work experience enquiry form :: Pennine Care NHS Foundation Trust

Full name Required

Date of birth (Please note, placements in patient areas are restricted to over 18’s only) Required

Home address

Address 1

Address 2

City

County

Country

Postal Code

Email address Required

Phone number Required

Your school/college/university

Course title (if currently studying)

Have you already approached a staff member about a placement? If yes, please give their name Required

Where would you like a placement? (Tick all that apply) Required

Bury

Oldham

Rochdale

Stockport

Tameside

Do you require any reasonable adjustments to support you with your placement? If yes, please give details Required

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Work experience enquiry form