<p> THE HIGH ARCAL SCHOOL WORK EXPERIENCE EMPLOYER PLACEMENT INFORMATION FORM</p><p>Dear Employer, you have been given this form to confirm that a WEX placement has been offered for the student named below. If you have agreed please complete and return this form to the school by 7th March 2017 STUDENT NAME FORM</p><p>PLACEMENT FROM: 17TH JULY 2017 TO: 21st JULY 2017 DATES COMPANY INFORMATION (These details must be completed in full, field marked with * are essential) * NAME OF COMPANY: * COMPANY ADDRESS (Placement Address if different from Company (Must Include Full Post Code) Address)</p><p>POST CODE: POST CODE: * COMPANY TELEPHONE COMPANY FAX No NO COMPANY MOBILE NO. CONTACT EMAIL ADDRESS * NAME OF CONTACT Mr/ Mrs/ (who has agreed the placement) Miss/ Ms/ Dr In the instance there is a need, how would you like to receive further correspondence from the school? EMAIL POST FAX COMPANY INSURANCE DETAILS Please indicate your Employer Liability Insurance (ELI) arrangements. A minimum limit of £5m indemnity is required: a) ELI (Min £5m indemnity) is in place and will be for the placement: (please tick as appropriate) b) ELI (Min £5m indemnity) is not in place, but will be for the placement: (please tick as appropriate) c) ELI (Min £5m indemnity) is not in place and will not be in place for the placement: (please tick as appropriate) In this instance please contact Dudley EBP (01384 813718) for further advice. GENERAL PLACEMENT INFORMATION In what sector of industry/commerce is your company? Eg Retail, Engineering, Construction What kind of work/ tasks will the student be undertaking? Eg Retail Assistant, Admin Assistant, Engineers’ Assistant Where/ Who should the student report to on the 1st Day?</p><p>Will the student need any specific work clothes for your placement? If YES please detail Not including PPE (Personal Protective Equipment), do you have any dress code requirements? If YES please detail What hours will the student be working? FROM: TO:</p><p>We encourage students to attend a pre-placement visit/ Interview? This would normally take place after 3.30 pm on a school day, OR If this is not convenient can you please suggest an alternative date below. Alternative date for pre-placement visit/ Interview:</p><p>PLACEMENT AGREEMENT SIGNATURE POSITION PRINT NAME DATE Please note that there may be a requirement for a H&S verification visit where our records show your details are new or need to be renewed. In which case, you will be contacted in the near future. THANK YOU.</p><p>Finding Your Own Placement Guidance</p><p>Please make sure you read the information below and ensure you pass this information onto the Company before arranging a placement of your own.</p><p>Insurance The company MUST have Employer’s Liability Insurance and Public Liability Insurance in order for the placement to go ahead. We will require proof of this nearer the time (a copy) and the Insurers to be notified of the pupils taking part in Work Experience with the Company.</p><p>Health and Safety Checks All work placements are subject to a Health & Safety prior to the start. A representative of Dudley Education Business Partnership will undertake a Health & Safety visit of the Company on our behalf prior to the student doing a Work Experience placement. A central database is held of all companies who have been vetted for health and safety and where current information already exists no additional visits will be required. </p><p>Out of Area Placements Whilst these are an exciting prospect for students, Health & Safety checks will still need to be undertaken on companies outside the Dudley borough. This is co-ordinated by Dudley EBP however issues arise as these are not a priority to other areas and inevitably they are left to the last minute or not completed at all. Out of area checks may also be chargeable. PLEASE NOTE a visit that is out of area (Dudley) may be charged between £30.00 - £60.00 for that visit. This charge will have to be paid by the parent\guardian in advance (by cheque) for the Health & Safety visit of their son/daughter. </p><p>Please sign below to confirm you are aware and understand the above Health & Safety information and will agree to pay for charges should they arise.</p><p>Parent/guardian</p><p>Signature ……………………………………………………………………………………Date ……………………………………..</p><p>For further information/ guidance on finding your own placement please refer to Work Placements: A Parent’s Guide Leaflet enclosed. Parental Consent Work Experience Form</p><p>CONSENT I give permission for Name……………………………………………..Form ……………. to participate in the school's arrangements to support Work Experience. In addition I have considered the route, time and mode of transport my child will use to get to and from the placement. I understand that it is a condition of the scheme that my son/daughter will not receive any payment in the form of a wage.</p><p>I have read and understood the Placement Employer Risk Assessment for Young Persons (attached if applicable).</p><p>Parent/Carer Name (Printed) ...... </p><p>(Parent/Carer ) (Signature) ...... </p><p>Date ...... </p><p>School Contact Information School Contact Mrs J. Busby Work Experience Administrator Name: The High Arcal School, High Arcal Drive, Sedgley, West Midlands DY3 1BP School Contact 01902 677754 Ext 144 No: PLEASE RETURN TO:-</p>