Full Name
Date of Birth
Home Address
Email Address
Telephone Number
School/College/University Name
Current Year Group
Subjects Studying
Preferred Placement Dates
Length of Placement
Preferred Office Location DarlingtonDurhamMiddlesbroughNewcastleYork
Area of Interest
Emergency Contact Name
Relationship to You
Emergency Contact Telephone Number
Do you have any medical conditions, allergies or additional needs that we should be aware of? (If yes, please provide details)
Do you require any adjustments to support you during your placement?
Does your school, college or university require any documentation to be completed by Clive Owen LLP?
NoYes
If yes, please provide details
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Please tell us why you are interested in completing an internship with Clive Owen LLP and what you hope to gain from the placement.
I confirm that the information provided in this application is correct to the best of my knowledge.
Applicant Name
Applicant Signature / Typed Name
Date
Is the applicant under 18?
Parent/Guardian Name
Parent/Guardian Signature / Typed Name
I confirm that I am the parent/guardian of the applicant and consent to them undertaking an internship placement with Clive Owen LLP.
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