About You

Work experience/placement duration*

Short term (up to 2 weeks)

Long term (1 month or more)

Name*

Age

Email address*

Your Address*

Phone number*

Preferred start date*

Preferred end date*

Course of study*

Department

School/College/University Address*

School/College/University Telephone

Teacher/Lecturer Name

Parent/Carer/Guardian Name*

Parent/Carer/Guardian Telephone

Work Experience with Leicestershire Fire and Rescue Service