Work Experience Application

Application for work experience placement - September 2025

Minimum age is 16 years old - No maximum age

Form

Please read before completing this application form. Your electronic signature at the end of this form will be verification that you have read this information.

1. Please be clear with the dates you are requesting to attend.
2. You can apply for a placement of a maximum 5 days.
3. All elements of this form must be completed.
4. You must be 16 years of age or older to gain a placement or 18 years for mental health.
5. You may only be allocated one department for the duration of your placement depending on availability.
6. Please note that all placements are strictly 'observation only' and you will not be providing patient care on a Ward placement.
7. We are unable to provide any financial support for travel or meals whilst on your placement.
8. If you are successful in gaining a placement, there are some mandatory Aspire E-Learning programmes that must be completed prior to starting your placement. Further details of these will be given to you if your application is successful.
9. To be considered for one of our placements we accept applications in January, May and September. All applications received out of these months will be disregarded.

Your application is important to us and we will do our best to accommodate your request, however we do receive large volumes of applications and can’t accommodate everybody. We will only contact you if you are successful in securing work experience with us. We will do this 2-weeks prior to the start date of your placement. It is not necessary to contact us unless you have any queries regarding the confirmed work experience placement. Please ensure you check your spam box regularly as some of our emails may deliver straight into that folder and subsequently you may miss communications from us. This application window allows you to apply for placements during November & December 2025 and January & February 2026. If you are wanting a placement later in the year, please wait for the next application window in January 2026.

Please be aware that an application for Work Experience does not guarantee a placement, although we will endeavour to support your request.

Please note we do not have any work experience placements available at Royal Preston Hospital, Chorley Hospital or Blackpool Teaching Hospitals at the moment. Please do not submit an application for these Hospitals as it will not be processed. Please check back in January 2026 for any updates.

If you are seeking a placement within mental health then please use the Mental health application form.

Information sharing - By completing this form, I agree that my information can be accessed by the Careers Team to facilitate an appropriate Work Experience placement based on my request.

The application window will close on Tuesday 30th September at 16:00

Please note, each location has a maximum capacity in terms of placements they can offer, by applying, this does not guarantee you a placement however we will keep you updated as we process your application. Priority for placements is given to students within our catchment areas.

Is this application for your block T-Level placement?(Required)

Yes

No

Please contact your College Tutor to arrange a T-Level block placement with us

Personal Details

First Name(Required)

Surname(Required)

Address(Required)

Street Address Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Telephone(Required)

E-mail Address(Required)

Date of birth *Please note that all applicants must be a minimum of 16 years of age(Required)

DD slash MM slash YYYY

Endorsement or Reference(Required)

In the space above, please provide an email address for an individual who will be happy to endorse your application for Work Experience. This should be a teacher, tutor, Work Coach, colleague or professional, who has known you for 2 years or longer and who is not member of your family. For Children in Care/ Care Leavers this could be your Social Worker or Personal Advisor. Please note that we will be contacting this person for their verification and your Work Experience application is subject to us receiving confirmation from this individual. The email address provided should be educational or professional, not for example, hotmail or gmail.

Do you have any current medical conditions or health issues we should be aware of that would prevent you from undertaking certain tasks? These could include hidden disabilities as well as visible. Please advise of any resonable adjustments we can make to support your experience.(Required)

Yes

No

Do not wish to disclose

If 'Yes', please provide details:

Current School/College/University:

*If Applicable*

Year Group:

*If Applicable*

Course of Study (e.g. GCSEs, A-Levels, T-Levels, BSc, etc.):

*If Applicable*

If you are not in education, please tick below:

I am not in education

If you are in employment and not in education, please give details (Job Title and Employer):

How did you hear about this opportunity?(Required)

Careers EventSchool/ CollegeSocial MediaParents/ Carer/ GuardianDWP/ Job CentreOther

If other - please state below

Placement Details

Are you interested in a Primary Care or Social Care Placement? This may include Pharmacy, General Practice, Optometry, Dentistry

Yes

No

Please select the geographical area where you would like to undertake the placement(Required)

Barrow

Lancaster

Kendal

Preston

Chorley

Blackburn

Burnley

Fylde

County Hall in Preston - Integrated Care Board Placement

Placement areas - please pick a MAXIMUM of TWO areas of interest:

Audiology

Anaesthetics

Biomedical Sciences (Biochemistry)

Biomedical Sciences (Haematology & Blood Transfusion)

Biomedical Sciences (Histology)

Biomedical Sciences (Microbiology)

Catering

Chaplaincy and Faith Support

Cleaner (Domestic)

Clinical Investigations

Dietetics & Dietitians

Estates (Electricians, Plumbers, Joiners, Construction etc)

Finance

IT and Digital Services

Maxillofacial and Dentistry

Maternity (17+ Must have undertaken a Placement with UHMBT previously)

Medical Engineering

Medical Photography

Occupational Therapy

Ophthalmology & Eye Clinics

Pharmacy

Physiotherapy

Portering

Radiography

Research & Development (mix of clerical & clinical)

Wards (Medicine, Nursing, Health Care Support etc)

Placement areas - please pick a MAXIMUM of TWO areas of interest:

Audiology

Biomedical Sciences (Various)

Catering

Chaplaincy and Faith Support

Clinical Investigations

Cleaner (Domestic)

Dietetics & Dietitians

IT and Digital Services

Occupational Therapy

Ophthalmology & Eye Clinics

Pharmacy

Physiotherapy

Portering

Radiography

Theatres

Wards (Medicine, Nursing, Health Care Support etc)

Placement areas - please pick a MAXIMUM of TWO areas of interest:

Audiology

Catering

Cardiology

Chaplaincy and Faith Support

Cleaner (Domestic)

Estates (Electricians, Plumbers, Joiners, Construction etc)

Maxillofacial and Dentistry

Occupational Therapy

Ophthalmology & Eye Clinics

Pharmacy

Physiotherapy

Portering

Radiography

Theatres

Placement areas - please pick a maximum of TWO areas of interest:

Apprenticeship & Careers Team

Communications Team

Culture and Inclusion Team

Health & Wellbeing Team

Finance Team

Hidden

Clinical placement areas - please pick a MAXIMUM of 3 areas:

Audiology

Cardio-respiratory

Clinics

Dialysis Unit

Maxillofacial

Neurophysiology

Occupational Therapy - Max 2 day placement due to high demand

Ophthalmology

Pathology

Pharmacy

Physiotherapy – Max 2 day placement due to high demand

Speech & Language Therapy

Theatre - must be 18+

Wards – Medical/ Surgical

Xray

Hidden

Non-clinical placement areas - please pick a MAXIMUM of 3 areas:

Admin Offices

Digital Team

Education

Estates & Facilities

Finance

Health Informatics Team

IT

Medical Engineering

Medical Records

Research

SMRC – Based at Preston Business Centre, Watling St Rd, Fulwood, Preston PR2 8DY

Human Resources/ Recruitment/ OD Teams

Hidden

Clinical placement areas - please pick a MAXIMUM of 3 areas:

Cardio-Respiratory

Clinical

Diabetes

Occupational Therapy

Orthopaedics

Pharmacy

Physiotherapy - Max 2 day placement due to high demand

Podiatry

Renal

Wards – Medical/ Surgical

Xray

Hidden

Non-clinical placement areas - please pick a MAXIMUM of 3 areas:

Admin Offices

Education

Estates

Human Resources

IT

Medical Engineering

Placement areas - please pick a MAXIMUM of 3 areas:

Physiotherapy

Occupational therapy

Pathology

Radiology

Pharmacy

Electronic Bio-medical engineering

Audiology

Speech and Language Therapy

Podiatry

Opthalmology

Catering

Estates and Facilities

Placement areas - please pick a MAXIMUM of 3 areas:

Physiotherapy

Occupational therapy

Pathology

Radiology

Pharmacy

Electronic Bio-medical engineering

Audiology

Speech and Language Therapy

Podiatry

Opthalmology

Catering

Estates and Facilities

Unfortunately we are currently unable to place work experience students at Blackpool Teaching Hospitals. Please do not submit an application for a placement in this location as it will not be processed.

Unfortunately we are currently unable to place work experience students at Royal Preston Hospital. Please do not submit an application for a placement in this location as it will not be processed.

Unfortunately we are currently unable to place work experience students at Chorley District General Hospital. Please do not submit an application for a placement in this location as it will not be processed.

If your area of interest is not listed above, please state here and we will do our best to organise a suitable and/or an alternative placement for you:

Please select the 'weeks commencing' below as your placement preference dates. Details around days and dates will be established upon confirmation of your placement.(Required)

November 2025

Nov 3 to Nov 7

Nov 10 to Nov 14

Nov 17 to Nov 21

Nov 24 to Nov 28

December 2025

Dec 1 to Dec 5

Dec 8 to Dec 12

January 2026

Jan 12 to Jan 16

Jan 19 to Jan 23

Jan 26 to Jan 30

February 2026

Feb 2 to Feb 6

Feb 9 to Feb 13

Feb 16 to Feb 20

Feb 23 to Feb 27

Choose which days you would prefer(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Is this placement request linked to your School/ College work experience placement dates?(Required)

Yes

No

If you have an NHS contact/employee within a hospital site who has agreed to support your placement, please state their full name and job title below. Please note, this person must have committed to directly supervise you, not just advised you to apply.

Please outline why you have chosen these areas for a preferred placement? Including details of what skills and benefits a placement would provide you and also information on your future aspirations (minimum of 100 words)(Required)

Emergency Contact Details

Name of emergency contact:(Required)

Relationship to emergency contact:(Required)

Telephone number of emergency contact:(Required)

Email address of emergency contact(Required)

Agreement

Work experience applicant to complete. Please sign below to show agreement to the following statements:

1. All the information given on this form is correct;
2. I give consent for the Careers & Engagement Team to store and file this information electronically and on paper;
3. I understand that I have the right to request erasure of this information;
4. I will hold in confidence any information about the employer, staff, patients and patient’s families which I may obtain during the placement;
5. I am aware of the acute nature of the placement environment and that I may be exposed to unexpected situations.

Please print your name as a way of confirming you agree to the above conditions.(Required)

Date(Required)

DD slash MM slash YYYY

Equality, Diversity and Inclusion Monitoring

We collect this information to monitor the diversity of our work experience applicants as part of our effort to ensure that we are accessible to all. You do not need to share any of this information with us but if you do, it can help us to make improvements to how we promote and co-ordinate our work placement opportunities across Lancashire & South Cumbria. If you would prefer not to share this information, please select the 'prefer not to say' option.

Gender(Required)

Female

Male

Non-binary

Gender Neutral

Transgender

I prefer not to say

If you choose to self-describe, please give details below:

Disability(Required)

Yes

No

If 'Yes', please provide details:

Learning Disability(Required)

Yes

No

If 'Yes', please provide details:

I would describe my ethnic group as:(Required)

White

Mixed

Asian/ Asian British

Black/ Black British

Chinese

Other

If not listed, please state:

Sexual Orientation(Required)

Bisexual

Gay or Lesbian

Heterosexual or Straight

Prefer not to disclose

A sexual orientation not listed

If not listed, please state:

Are you currently or have been in care of the local authority / foster care?(Required)

Yes

No

Do not wish to disclose

Are you a care leaver?(Required)

Yes

No

Do not wish to disclose

Rehabilitation of Offenders Act

Because of the nature of the work experience placement for which you are applying, this post is exempt from the provisions of section (2) of the Rehabilitation of Offenders Act 1975. Applicants are therefore required to disclose any criminal convictions, bind overs or cautions.

Have you been convicted of a criminal offence, been bound over, warned, cautioned or reprimanded or are you currently the subject of any police investigation?(Required)

Please SelectNoYes

If ‘Yes’, please provide brief details:

Disclosure of the above will not automatically exclude you from gaining a place on this programme. However, failure to disclose on this form any of the above will result in your removal from the placement. All information provided on this form will be treated in strict confidence.

The Work Experience window is now open and will close on Tuesday 30th September 2025 at 4pm