ENROLMENT FORM

Please complete ALL sections of the form in BLOCK CAPITALS

PERSONAL DETAILS
Surname First Name Title
WHITEHOUSE JOE MR

Date of Birth Sex Nationality NI number

14/02/2004 MALE BRITISH PJ 82 22 10 C

Address
74 CENTURY CLOSE

ST AUSTELL

CORNWALL Postcode PL25 3UZ

Tel (Home) N/A Tel (Mobile) 07465 422940

Email JOEWHITEHOUSE04@OUTLOOK.COM

COURSE
Title

Start Date Finish Date

Ethnicity (please tick appropriate box)

White - British  White - Irish  Any other White background 

Asian  Black or Black British - African  Black or Black British –

Caribbean 

Any other Black Background  Chinese  Mixed – White & Asian 

ChanniCool Training Services Limited Telephone: 01752 696471

Unit 2 Broadley Court, Website: www.channicool.co.uk
Parkwood Close, Email: info@channicool.co.uk
Plymouth. PL6 7SQ Company Registration Number: 07025855
 EMPLOYER DETAILS

A.T REFRIGERATION LTD

Address
15 FIGGY ROAD

NEWQUAY

CORNWALL Postcode TR8 4WB

Tel (work) 01637 859333 Email ALAN@ATREFRIGERATION.COM

ADDITIONAL SUPPORT

Do you have any medical condition, physical or learning difficulties that you wish to make
Channicool aware of? No (delete as appropriate)
If yes, please state or speak to a member of staff in confidence

_______________________________________________________________________________________
_______________________________________________________________________________________
____________________________________________________________________________________

APPLICANT SIGNATURE

To the best of my knowledge the information on this application is accurate and complete.
Data Protection Act 1998 / GDPR: I agree to ChanniCool Training Services Limited processing personal
data contained on this form. I agree to the processing and sharing to third parties, of such data for any
purpose connected with my studies or my health and safety whilst on ChanniCool Training Services Limited
premises or for any other legitimate purpose.

I OPT IN to agree to my details being kept and used for future marketing, to allow me to be updated
on future courses.
 I have been made aware of my responsibility as an apprentice and acknowledge I am responsible
for producing a minimum of 3 pieces of work based evidence for my development journal every year
and I must complete and submit to ChanniCool an off the job training record to cover 20% of my
work time every month.

Name: JOE WHITEHOUSE

01/07/23

Signature...................................................................... Date

ChanniCool Training Services Limited Telephone: 01752 696471

Unit 2 Broadley Court, Website: www.channicool.co.uk
Parkwood Close, Email: info@channicool.co.uk
Plymouth. PL6 7SQ Company Registration Number: 07025855