In-Trac Associate Application

1. Name

2. Address

3. Email Address

4. Telephone Number

5. What area(s) of work would you be interested in undertaking for In-Trac?

Training - child care

Training - child care

Serious Case Reviews

Consultancy - child care

Consultancy - adults

Please specify other areas below:

6. Other areas of interest

7. Referees

Please give the names and contact details of two referees who can comment on work you have undertaken which is similar to that you have specified above.

1st Referee

Name

Address

Email Address

Telephone Number

2nd Referee

Name

Address

Email Address

Telephone Number

8. Insurance

Do you have professional indemnity insurance
Yes No

If so to what value?

Do you have public liability insurance
Yes No

If so to what value?

We will need copies of insurance certificates before we can commission work from you.

9. How far are you prepared to travel in one day (i.e. how many hours from home approx.)?

10. Are you prepared to spend nights away from home for work purposes?

11. Please indicate what commitments you make to keeping up-to-date with current literature and research in your particular area of expertise, and if possible give examples of how this has been incorporated into your recent work.