Learner Details

Name*
Date of Birth*

Level 3 Dental Nurse - Eligibility Criteria

Did Aspiration Training support you to find your employment?**
Are you a citizen of the UK?*
Have you been a resident in the UK or European Economic Area (EEA) economic area for at least the previous three years?*
Do you have the right to work in England?*
Please attach evidence of right to work*
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Are you self-employed*
Has the learner's contract of employment been seen?*
Have you completed your probation period with your current employer?*
Have you completed all or part of this apprenticeship previously or similar qualification?*
Are you currently undertaking another qualification or form of training?*
Do you earn at least the apprentice national minimum wage for your age group?*
Will you have access to a wifi / internet enabled device (iPad, PC, Laptop etc) for the duration of your programme?*
Will you have access to a wifi network / the internet for the duration of your programme?*
On a scale of 1 to 10, how confident are you in using information technology (10 being very confident and 0 being not at all confident)?*
Is there any reason why you cannot complete this qualification in the agreed timescale? For example: going to university, work/time commitments, changing employer?*
Is your job role defined as being a Dental Nurse with decontamination access and responsibilities?*
Do you have a contract showing the hours you are contracted to as an apprentice dental nurse and a CV?*
Do you complete 75% of your working hours chairside?*
Have you booked or completed the vaccinations required for this role?*
Have you access to all the required treatments for the Dental Nursing Qualification within the Apprenticeship Standard as below?*
Have you access to all the required treatments for the Dental Nursing Qualification within the Apprenticeship Standard as below?
  Yes No
Composite/GIC/Amalgam restoration
Decontamination
Denture imps - Bite, Fit & Try
Examination
Extraction
Preventative treatments
Prosthodontic Preparation and Fit
Radiographs
RCT (Endodontic Procedures)
Scale and Polish
Do you have access to be able to give post operative advice, oral health advice to a patient under prescription and supervision from Dentist?*
Have you had an induction which covered the COSHH requirements and practice policies and procedures?*
Have you completed any of the following mandatory training:*
Have you completed any of the following mandatory training:
  Yes No
Basic First Aid
Fire Safety
Is this enrolment contracted via Salisbury NHS FT Managed Procurement Services?*
Have you been DBS checked?*

Level 3 Dental Nurse

Additional Learning Needs (ALS) Pre-Screening Questionnaire


For Aspiration Training to be able to provide possible aids and adaptations for your programme, along with support and/or potential flexibilities for you to achieve your aims, please could you help us by identifying whether you consider yourself to have any learning support need, disability or long-standing medical condition which may affect your learning? 

 

Recognised disability*
Visual impairment (does not include wearing glasses)*
Hearing impairment*
Diagnosed mental health difficulty*
Dyslexia*
Dyscalculia*
Dyspraxia*
Autism spectrum disorder*
Asperger’s syndrome*
Recognised learning difficulty*
Temporary disability after illness or accident*
Speech, language and communication need*
Has any of your past or present behaviour been deemed to have been challenging in nature and/or affected your learning?*
Have you needed any support or intervention to maintain positive mental health in the past which may impact your learning?*
Do you have an Education and Health Care Plan or 139A in previous education?*

2. Previous education experiences



Have you ever had any of the following, please select all that apply

Support with speech and language therapy*
Attended a special education needs (SEN) school*
Received extra time in exams*
Had a reader and/or a scribe in exams*
Used special software such as text-to-speech or speech-to-text**
Use coloured overlays or coloured glasses when reading*
Have you ever felt some of these measures might have been helpful or were actually needed, but were not available to you? *

3. Learning and studying



Please answer all the questions in this section

ALS Referral

1.Initial Assessment Results

Declaration

  • I confirm that all the information on this form is correct, and I have met with the individuals named above to provide all necessary advice and guidance relating to the suitability of planned qualifications.
  • I have discussed with the employer the need for a minimum average of 6 hours per week (20% of working hours if working fewer than 30 hours per week) of the learner’s time to be spent on the Apprenticeship Off-the-job development. The learner and the employer have agreed to fulfil this obligation.
  • I confirm the learner is being enrolled on an appropriate training programme for the individual.
  • I confirm that the job role is appropriate to implement all of the required knowledge.
  • I confirm the learner is suitable for an apprenticeship with a minimum duration of 53 weeks.
*
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