Kickstart Form

Date :*

Companies House Reference number :*

Client/Employer Name :*

Registered Company Name :*

Office contact :*

Mobile number :*

Email address :*

Company Address :*

City :*

County/Region :*

Postcode :*

Sector(s) of Business :*

Number of Placements offered :*

Preferred start date :*

Charity Commission number (If received) :*

Office of the Scottish Charity Regulator number(if received) :*

Placement Job Title(s) and Job Location(s) :*

Placement details and Job description(s) :*

Evidence that the Placement(s) is/are created just for the Scheme :*

Support provided to the Young Candidate :*

Level 37, 1 Canada Square, Canary Wharf, London E14 5AA

020 7038 8029

dpuri@quantumgroups.co.uk prisca@quantumgroups.co.uk