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Priya

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Priya

PROTOTYPE

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Enrolment form · Check your answers

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Your course opens as soon as the form is in.

About you

Your title: Ms
Your first name(s): Priya
Your surname: Shah
Your previous surname: Left blank
Known as: Left blank
Your pronouns: she/her

Where we can reach you

Your home address: 12 Alder Road, Leeds, LS6 2AB
Your date of birth: 14 March 1989
Your mobile number: 07700 900123
Your email address: priya.shah@meridiancare.example

Your key details

National Insurance number: QQ 12 34 56 C
Passport issuing country: United Kingdom
Passport number: 123456789
Do you need a visa or other permission to live in the UK?: No

Where you work

Name of employer or company: Meridian Care Ltd
Employer website: www.meridiancare.example
Workplace postcode: LS1 4AP
Employer email: hello@meridiancare.example
Line manager name: Helen Ward
Line manager email: helen.ward@meridiancare.example

Who to call in an emergency

Name of Emergency Contact: Arjun Shah
Relationship: Husband
Mobile number: 07700 900456

Your ethnic origin

Sensitive information · only you, the training provider and trainrs’ owner see this; never your employer

Ethnic origin: 99 Not Provided

Nationality and residency

Nationality: British
Country of Normal Residence: United Kingdom
Have you been legally resident in the UK for the past 3 years?: Yes
If English is not your first language, please state your first language: Left blank

Criminal convictions

Sensitive information · only you, the training provider and trainrs’ owner see this; never your employer

Do you have any unspent criminal convictions?: No
Do you have any spent criminal convictions?: No

Disabilities and learning difficulties

Sensitive information · only you, the training provider and trainrs’ owner see this; never your employer

Do you consider yourself to have a learning difficulty, disability or medical condition (including severe allergies)?: No

Your qualifications

Highest level of qualification achieved to date: Level 6 (e.g. bachelor’s degree)

Your job

Current Job Title: Care Quality Lead
Industry / Sector: Adult social care
Hours Worked per Week: 37.5

Your declaration

Accurate and complete: I confirm
Print name: Priya Shah
Date: 14 December 2026

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