Title
Please select... Mr Mrs Miss Ms

Surname

First name

Staff number

Home postcode

Job title

Department

Department address (in full)

Email (if used)

Department telephone

Age
Please select... Under 20 21 - 41 41 - 60 Over 60

To which staff group do you belong?
Please select... Management, Professional & Administrative Technical & Related Operational

Working Hours
Please select... Full-time Part-time

If on a temporary contract please supply the following information:
start date: end date:

All staff receiving an allowance from Learning Works must have their choice of learning approved by Learning Works and must complete a Personal Development Plan (PDP).

NB: Remember you must return your allowance registration form before the closing date of 31st May 2012 to make sure you get your allowance, even if you have not yet decided what you want to learn.

By clicking Submit I confirm that the learning allowance I am claiming will be for my own personal use and I understand that it is a disciplinary offence to use it for anyone other than myself