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Application form

Section 1

About you
What age will the applicant be at the beginning of the placement?
Please give a range of available dates if possible, of when the placement could start and end.
Under 18
Previously Attended Placement at UHNM
Please provide the dates and departments you were previously placed in.
Placement details
Please note you can apply for both sites (dependent on requested area).
Which department or occupation would you prefer to be placed in?
If it's not possible to place you in your prefereed area, what would your alternative choices be?
Please tell us if you have you previously contacted a UHNM department or staff member regarding this placement, other than the Work Experience Team? If you have contacted someone, please tell us who.
The Trust is committed to supporting people who may have particular requirements that need to be taken into consideration when undertaking work experience. If you have any additional considerations or requirements, please provide details below and we will make every effort to ensure that your needs are met.