Work experience application form

Please note that this form will need to be completed with a teacher or representative from your school/college.

Student details

First name

Surname

Address

Postcode

Telephone number

Age

14 - 16

16 - 18

18+

Emergency contact details

Emergency contact name

Emergency contact telephone number

Emergency contact email address

Emergency contact

Please note that all correspondence will be emailed to the above address. Please check your emails regularly.

Date of placement

From

Please state why you wish to undertake the work experience placement:

School / College details

Has your application been approved by your school/college?

School / College name

Work experience coordinator

Telephone number

Year group or course title

Risk assessment

Prior to placement commencement, a risk assessment will need to be provided for each student from the school/college.

Placement support needs

Does the student require any additional learning support?

Yes

If the student requires additional learning support, please give details:

Does the student have any medical condition, mental health issue or disability that we need to be aware of?

Yes

If yes, please give details:

Statement of support from teacher/lecturer

Please state how working in the chosen area will support the student:

Teacher / lecturer name

Position

Telephone number

Data protection and privacy notice

Privacy notice

We will use the information provided by you in order to consider a work experience placement and if the placement is granted for any correspondence and contact prior to and during your placement with us. The basis under which the Council uses personal data for this purpose is Contract.
Please note: The mobile telephone number and email address supplied will be used for all communications in relation to this applications and if successful any future communications in relation to your placement.
We will use the information provided by you for this purposes. The basis under which the Council uses personal data for this purpose is Contract. The information provided by you includes the following special categories of personal data
• physical or mental health
Information in these categories is used by the Council for the purposes of performing or exercising obligations or rights of the controller under employment law and for reasons of substantial public interest, in accordance with the provisions of the Data Protection Act 2018.
Details of your application including your personal details will be stored in our archives and database for up to 12 months following successful completion of the application process. If however you are the successful candidate your details will be retained in accordance with the Councils retention schedule which can be found at www.mansfield.gov.uk/privacy or requesting a copy by writing to the Data Protection Officer, Mansfield District Council, Chesterfield Road South, Mansfield, Notts, NG19 7BH
The information provided by you may also be used for the purpose of any other function carried out by the Council. Information about these functions and the legal basis on which information is used by them, your rights and the Council’s Data Protection Officer (DPO) can be found on the Council’s detailed privacy notice which can be found at www.mansfield.gov.uk/Privacy on the Council’s website or requesting a copy by writing to the Data Protection Officer, Mansfield District Council, Chesterfield Road South, Mansfield, Notts. NG19 7BH.

Data consent

Yes, I give permission to store and process my data

Spam protection

Page last updated 10 September 2025