Level 5

CIPD Intermediate Certificate in

Human Resource Management or
Diploma in HR Management

APPLICATION FORM
 If you have any queries when completing this application form, please don’t hesitate to contact a member of the MOL
Customer Support team on 0345 203 2103 for assistance. Please tick boxes as appropriate and complete this form in
BLOCK CAPITALS using black ink.

Please indicate here if you are applying for L16 – Learning difficulty

Certificate in HR Management 01 Moderate learning difficulty

Diploma in HR Management 02 Severe learning difficulty
10 Dyslexia
1. Personal details
11 Dyscalculia

Mr Mrs Miss Ms Dr 19 Other specific learning difficulty

20 Autism spectrum disorder
First name ...........................................................................................................
90 Multiple learning difficulties
Surname ..............................................................................................................
97 Other
Date of birth ....................................................................................................... 99 Not known/Not provided

Home address ................................................................................................... Other .....................................................................................................................

.................................................................................................................................
3. Ethnicity
Postcode .............................................................................................................
Please indicate which category best describes your ethnic origin:
Nationality ..........................................................................................................
White Mixed/Multiple ethnic group
Home telephone ...............................................................................................
31 English/Welsh 35 White and Black
Email ..................................................................................................................... Scottish/Northern Caribbean
Irish/British
Mobile phone ..................................................................................................... 36 White and Black
32 Irish African
CIPD membership number (if in membership) ....................................
33 Gypsy or Irish 37 White and Asian
traveller
NB: CIPD membership is mandatory for studying this programme. 38 Any other Mixed/
If you do not have membership, please visit 34 Any other White Multiple ethnic
cipd.co.uk/membership for further information. background background

2. Support needs Asian/Asian British Black/African/Caribbean/

Black British
If you need support because of the following, please tick as 39 Indian
appropriate below. This will help us make any reasonable 44 African
40 Pakistani
adjustments to support you in your studies.
45 Caribbean
Please see the Terms and Conditions on the reverse of this form 41 Bangladeshi
for how the data in sections 2 and 3 will be used. 46 Any other Black/
If you prefer not to provide this information, please tick in the 42 Chinese African/Caribbean
boxes ‘Not known/Not provided’. 43 Any other Asian background
background
L15 – Health issue/Disability Other ethnic group

01 Visual impairment not corrected with glasses 47 Arab

02 Hearing impairment 98 Any other ethnic
group
03 Disability affecting mobility
99 Not provided
04 Other physical disability
05 Other medical condition
(eg epilepsy, asthma, diabetes) Candidates whose first language is not English must
demonstrate a high standard of both spoken and written
06 Emotional/Behavioural difficulties English to be admitted onto a CIPD programme.
07 Mental health difficulty
Please provide your IELTS level of proficiency: ...................................
08 Temporary disability after illness
(eg post-viral) or accident .................................................................................................................................
09 Profound complex disabilities
10 Asperger’s syndrome
90 Multiple disabilities
97 Other
99 Not known/Not provided

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4. Education 7. Programme

Please give details of the highest level of education achieved. Preferred start month:.....................................................................................
Your education and career history will help us to identify how
you will benefit from this programme. Preferred location:............................................................................................

................................................................................................................................. Please indicate your preferred delivery method for each unit

................................................................................................................................. Core units

Classroom Live
Choice Online
.................................................................................................................................
Developing professional practice
Previously completed CIPD qualifications
Business issues and the context of human
................................................................................................................................. resources

................................................................................................................................. Using information in human resources

Professional education and membership(s) Managing and co-ordinating the human

resource function (Diploma only)
.................................................................................................................................
For Certificate, please select your optional units (3 of 5)
................................................................................................................................. Classroom Live
Choice Online
Employee engagement
5. Current employer details
Managing and co-ordinating the human
Your job title ...................................................................................................... resource function

Company name ................................................................................................ Improving organisational performance

Your work address ........................................................................................... Contemporary developments in employment

relations
.................................................................................................................................
Employment law
.................................................................................................................................
8. Learning materials delivery
Post code ............................................................................................................
Learning materials can be delivered to either your work or
Your work telephone ...................................................................................... home address. Someone must be present at the delivery
address to sign for delivery.
Your work email (if different) ......................................................................
Please tick the relevant box
Training manager name .................................................................................
Work address* Home address**
Training manager address (if different) ..................................................
Which email address would you like to use to access the virtual
................................................................................................................................. learning environment? Please tick the relevant box.

................................................................................................................................. Work email* Home email

Postcode ............................................................................................................. * Please ensure your work address and work email are provided
in section 5.
Training manager telephone ........................................................................
**Delivery time cannot be guaranteed.
Training manager email .................................................................................

9. Payment options
6. Career history
Please indicate who will be funding your programme fees:

Previous job title(s) Employer Dates My employer will be funding 100% of my programme
(please ensure section 11 is completed)
I will be funding 100% of my programme myself
(please complete section 12)
My employer and I will both be funding the programme
(please complete below)

......... .(% or £s) is my employer’s responsibility

(please complete section 11)

......... .(% or £s) is my own responsibility

(please complete section 12)

Please ensure section 5 is complete if company funded.

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10. Employer payment If you wish to pay by direct debit/credit card, please provide a
(to be completed by the employer) contact number. We will contact you on this number to arrange
Please see later in this application form for further information payment. Card or bank payments will not be processed until
and Terms and Conditions. your application has been approved and your programme
confirmed.
I confirm................................................................................................................
(name of employer organisation) accepts responsibility for the
payment of programme fees for programme(s) selected and
accepts that the fees are non-refundable. 12. Declaration
(to be completed by all applicants)
Learner’s name...................................................................................................
I confirm that I have a copy of the MOL Learning
Employing organisation (if different from above) Agreement and that the information contained in this
completed application form is correct and that payment
................................................................................................................................. details have been fully outlined in Section(s) 11, 12 (as
applicable).
Authorising manager’s name (individual)
I request MOL to reserve my place on the indicated
................................................................................................................................. programme and to order materials on my behalf. I
confirm I have read and understood the Terms and
Position/job title................................................................................................ Conditions and Data Protection information overleaf.

Manager’s telephone....................................................................................... I have also received advice and guidance on the

suitability of my programme of choice. I agree to pay
Manager’s email................................................................................................. all costs in full relating to my programme of study
and understand that fees are not refundable, even if I
Manager’s signature......................................................................................... decide to leave the programme early. I agree to attend
all activities that relate to the programme of study I am
Invoice details enrolled on. By signing this form I am declaring that the
contents are true and accurate, and that any inaccurate
Authorised invoice amount £....................................................................... information given knowingly or fraudulently may lead to
prosecution.
The invoice for the fees should be sent for the attention of

Name of department eg Accounts Payable Signed

................................................................................................................................. ...................................................................................................................

Date .........................................................................................................
Name of individual............................................................................................

Job title.................................................................................................................

Address................................................................................................................. The Learning Agreement

................................................................................................................................. The Learning Agreement summarises the main rights and

responsibilities of the learner and MOL.
.................................................................................................................................
On commencing studies with MOL, you have the right
Post code............................................................................................................. to expect:
• clear and accurate information and/or advice about our
Telephone............................................................................................................. learning programmes, programme costs, methods of study
and assessment, qualifications and progression opportunities
Email......................................................................................................................
As a learner, you have the right to expect:
Purchase order number..................................................................................
• high quality provision backed up by appropriate
administrative services
11. Personal payment
• appropriate access arrangements to help with a learning
Please see later in this application form for further information difficulty, disability, or other barrier which might restrict your
and Terms and Conditions. learning
• any complaint under the formal Complaints Procedure to
As a self-funding learner, I would like to arrange my payments receive a response within 15 working days and to be dealt
as follows (please tick appropriate box): with fairly
• access to MOL’s policies and processes
Full payment prior to programme start date
• your personal details to be handled sensitively and only
Payments by initial fee and instalment schedule disclosed to third parties in ways which support your
(Direct Debit form attached) progress and well-being or where required by law (please
note if your employer is contributing to the cost of your
I accept that the programme fees are payable in full and programme they will expect and receive progress updates)
non-refundable
• to be treated with respect regardless of age, disability,
I would like to pay my initial/full (please delete as gender reassignment, marriage and civil partnership,
appropriate) programme fee by: pregnancy and maternity, race, religion and belief, sex, sexual
orientation
Visa Mastercard
Switch/Delta Cheque
(cheques should be made payable to ‘MOL’ and must be
attached to this form)
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I, the learner, agree to:
• pay all programme costs that are due from me to MOL.
I understand that programme fees are not refundable
• take responsibility for my own learning, completing
all activities, examinations and assessments as per my
programme schedule
• conduct myself in a way which respects the rights of others
and complies with MOL’s policies and processes
• inform MOL within five working days if my contact details
change (eg new phone number, address)
• take responsibility for my registration and attendance at the
correct exams
Price and payment options
CIPD Level 5 Price
Diploma in HR Management £2995
Certificate in HR Management £2550
Please note there is no VAT to pay.
CIPD membership is mandatory for studying this programme.
Membership fees are not included in the price.
Additional information and summary
Terms and conditions
Paying for your programme
For company-funded learners (Employer payment)
An invoice will be issued for your programme fees. It will be
sent to the person and place stipulated in Section 11 prior to
the programme start date. Payment is due on receipt of invoice
and can be made by BACS, cheque or credit card. Please note
that, at this time, we do not accept direct debit payments
from employers (although we do accept them from individuals
paying for their own programme).
Purchase order numbers are usually essential for payment
of invoices, so please ensure that the PO number is stated in
your application.
If, after a period of 4 weeks following the programme
commencement date, your employer has refused or failed
to pay the required programme fees, then you, the learner,
become responsible for immediate payment of those fees in
their entirety. It is then your responsibility to claim back those
fees from your employer.
Financing
Prior to processing any applications for finance, central finance
at LTE Group will conduct a credit check on the organisation
sponsoring you. Should the organisation be found to have
an unsatisfactory credit score, then it will be required to
make full payment in advance of your commencement on the
programme.
For self-funded learners (Personal payment)
An initial payment is required upon application. This payment
will not be processed until your application has been approved
and your programme confirmed. The balance of learner fees
can be paid for either in full before the programme start date
(personal cheque or credit card) or via MOL’s instalment
schedule. The instalment schedule allows you to spread the
balance of your programme fees across the programme. After
the initial payment, instalments are taken monthly by direct
debit. Where a direct debit is cancelled, the outstanding balance
of the programme fees will immediately become due in full.
Learner applications will be delayed if programme application
forms or direct debit instructions are not correctly completed.
Programme applications will only be processed if accompanied
by the required initial payment details and direct debit mandate.
MOL will provide learners opting to pay by credit/debit card
with a secure online payment portal.
No application will be processed until a non-refundable deposit
has been paid by the applicant. Please note, we are willing to
accept late applications, but only from candidates who make an
immediate payment of the required deposit upon applying.
Any student whose fees remain unpaid (whether self or
employer-funded) will be withdrawn from the programme and
the balance of outstanding fees will be pursued by LTE Group.
Furthermore, any applications suspected to be fraudulent for
material or financial gain will be subject to prosecution.
CIPD membership
The Chartered Institute of Personnel and Development (CIPD)
requires all those pursuing CIPD approved qualifications
to be registered as members. Fees are separate to those
payable to MOL. There are a number of real benefits, including
subscription to People Management magazine, access to the
CIPD website, Library and Information Services and invitations
to Branch meetings for presentations and networking. The
CIPD has an online registration facility cipd.co.uk/membership
whereby you can pay by credit/debit card or your organisation
can be invoiced for the fees. It is your responsibility to
ensure that your CIPD membership is in place prior to the
commencement of your programme. Be aware that the CIPD
will not award certificates of completion to any learners
who have not registered with them as a member. For further
information please call 0345 203 2103.
Programme flexibility
We welcome applications from all individuals regardless of age,
disability, gender reassignment, marriage and civil partnership,
pregnancy and maternity, race, religion and belief, sex or sexual
orientation.
Once a learner has commenced a programme with MOL, it is
our policy, while the learner remains committed to pursuing
their qualification, to provide support to successful completion.
When you commence your programme of study, you are
committed to completing your programme schedule with
your assigned MOL group. Where you are unable to attend a
scheduled workshop/tutorial you must notify MOL (0345 203
2103) so that an alternative can be provided. Where you fail
to notify us, as above, you will be liable for a rebooking fee.
For leavers, no refunds are given in view of the provision of
materials and commitment of the majority of costs at the start
of the programme. A charge for administration will be made for
applicants who, having been accepted on a course, withdraw
from that course prior to the start date.
For funded qualifications
The information you provide will be anonymised and
aggregated and shared with other government organisations
and awarding bodies for the purpose of administration,
provision of career and other guidance, and statistical and
research purposes, relating to education or training. Other
organisations include the Department for Education, the
Department for Business, Energy and Industrial Strategy,
local authorities, Higher Education Statistics Agency, Higher
Education Funding Council for England, educational institutions
and organisations performing research and statistical work on
behalf of the Education and Skills Funding Agency or partners
of those organisations.
The Education and Skills Funding Agency uses European
Social Funds for the European Union to directly and indirectly
part-finance learning activities, helping develop employment
by promoting employability, business spirit and equal
opportunities, and investing in human resources. The Education
and Skills Funding Agency also administers the Learning
Records Service (LRS), which uses your learner information to
create and maintain a unique learner number (ULN).
Further information about partner organisations and the ULN,
and what they do, may be found at
gov.uk/government/organisations/education-and-skills-
funding-agency
gov.uk/topic/further-education-skills/learning-records-service
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Data Protection/GDPR
MOL respects your data, holds it securely and will give you
opt out choices for the different forms of contact. Please note
that if you opt out of all forms of communication where we
push messages, such as email, you run the risk of missing a
vital message for your learning. All important messages will be
posted to the virtual learning environment (VLE). Full details of
your choices are provided separately.

Please note that ‘webinars’ (any interactive online session)

are recorded and shared with learners via the VLE to support
revision and learning. In your contributions to these sessions
you must take responsibility for the information you share
about your organisation and the individuals within it, taking
care to be mindful of confidentiality and privacy issues.

Personal data collected on this form will only be used for the
purpose of learner programme administration, but may be
disclosed to appropriate bodies/organisations associated with
such programmes.
We may occasionally wish to update you on programmes that
may be of interest to you, your family or friends.

Please tick if you do not wish to receive this information.

Recorded webinars
Please note that the interactive webinar includes a feature that
allows audio, any documents and other materials exchanged or
viewed during the session to be recorded. By joining a session,
you automatically consent to such recordings and all of the
recordings will be available to view or download via MOL’s
VLE platform. In your contributions to these sessions you must
take responsibility for the information you share about your
organisation and the individuals within it, taking care to be
mindful of confidentiality and privacy issues.

Student membership
Some qualifications require the registration of the student
with the appropriate body. Details of the need to register will
be provided, appropriate to the qualification being studied,
and instructions will indicate the actions the learner needs
to take. Please note it may not be possible to complete your
qualification without holding the appropriate membership
which you may need to pay for directly to the membership
body.

Cancellation rights
Under the Consumer Contracts (Information, Cancellation and
Additional Charges) Regulations 2013 you have 14 days from
the day your order is made to cancel. In order to cancel you
must inform MOL within the 14 day period and you are liable
for the cost of returning any goods received. If the value of the
goods has been diminished by your handling, MOL may recover
the amount of this diminished value by deducting this amount
from your refund.

Your right to cancel and obtain a refund will be lost if you have
given MOL express consent to supply any services or digital
content during the Cancellation Period and the service has
been fully performed or the digital content accessed.

6
 Instruction to your bank
Please fill in the whole form and send it to:
LTE Group, Finance Department,

or building society to
Openshaw Campus, Ashton Old Road,
Manchester M11 2WH

pay by Direct Debit

Telephone (+44) 0161 674 3007
financear@ltegroup.ac.uk
www.themanchestercollege.ac.uk
Please use a black pen and write clearly in BLOCK CAPITALS.

Name(s) of account holder(s)

Service User Number 8 3 8 7 3 0

Reference

Instruction to your Bank or Building Society

Bank/Building Society
account number Branch sort code Please pay The LTE Group Direct Debits from the account
detailed in this Instruction, subject to the safeguards assured
by the Direct Debit Guarantee. I understand that this

TMC Fin DD Form v8 12/17 - MOL

Instruction may remain with The LTE Group and, if so, details
Name and full postal address of your Bank or Building Society will be passed electronically to my Bank/Building Society.

To the Manager Bank/Building Society Signature(s)

Address
Date

Banks and Building Societies may not accept Direct

Postcode Debit Instructions for some types of account.

This is not part of the Instruction to your bank or building society and must be detached by The LTE Group before submission to the paying bank

OFFICE USE ONLY

Payment details Learner name/EBS number

Programme fee £ Programme title

Course code Receipt no.

Total due £
Sales Agent

Less payment received £ Authorising officer

Preferred payment date (monthly)

MOL initial payment due by card £
1st of month 15th of month
Month Year Month Year
Balance to be paid by Direct Debit £
Start date End date
Normal monthly payments £ If you wish to receive information regarding your Direct Debit instruction
by email, please confirm email address to used for this here
Number of monthly payments

THIS GUARANTEE SHOULD BE DETACHED AND RETAINED BY THE PAYER.

The Direct Debit Guarantee

• This Guarantee is offered by all banks and building societies
that accept instructions to pay Direct Debits.
• If there are any changes to the amount, date or frequency of
your Direct Debit, The LTE Group will notify you ten working
days in advance of your account being debited or as otherwise
agreed. If you request The LTE Group to collect a payment,
confirmation of the amount and date will be given to you at
the time of the request.
• If an error is made in the payment of your Direct Debit, by The
LTE Group or your bank or building society, you are entitled to
a full and immediate refund of the amount paid from your bank
or building society. If you receive a refund you are not entitled
to, you must pay it back when The LTE Group asks you to.
• You can cancel a Direct Debit at any time by simply contacting
your bank or building society. Written confirmation may be
required. Please also notify us.

MOL is a trading name of The LTE Group. All references marked with an ® are registered trademarks of The LTE Group.
MOL T 0345 203 2103
Whitworth House T 0161 203 2103
Ashton Old Road
Manchester E enquiries@mollearn.com
M11 2WH W mollearn.com

© MOL