Withdrawn

This publication has been withdrawn. It is no longer current.

*Insert organisation logo here
	*Name of organisation
Full business address
: Full business telephone number	
	;: Full e-mail address     	
*or equivalent headed paper, suitably annotated							

Full name of young person:		
Date of birth:		
Age participant started on provision:		
National Insurance Number (NINO):		
Employee reference number (if applicable):		
Employment Start Date (if applicable):		
Job Title (if applicable):		
Number of hours worked  per week (if applicable):		

	Please mark all that apply by entering X in the left hand column below:
	
	The young person is still employed here.	
	The young person has been in continuous employment since starting work here and there have been no changes to the hours worked each week.	
	The young person is still employed here but has had the following breaks in employment (list the dates the young person was not employed):
dd/mm/yy to dd/mm/yy	
	The young person is no longer employed here. He/she left on dd/mm/yy (insert date)	
	The young person is aged under 18 and the employment includes a training element of at least 280 hours of guided learning hours.	

The person named below has verified this information:

Name:		
Occupation:		
Contact Details:		
Signed:
		
Dated:

Kind Regards

(Insert name)