INSERT							INSERT
SCHOOL LOGO 						HOST ENTITY LOGO 											

PERSONALISED WORK-RELATED LEARNING PROJECT:  WORK PLACEMENT
(Attached to Agreement executed on ……/pursuant to Framework Agreement executed on….)

FAC-SIMILE MODEL

Trainee
Surname	First Name	
Tax code	
Born in 	 on 	
Citizenship 	
Resident in	 post code 	
Address 	
School attended	
Type of school programme attended	
Year of course attended	 

Employer
Company Name 	
VAT Number 	
Registered address 	
Locality	 post code 	
Telephone 	 Fax 	
e-mail	certified e-mail	

Legal Representative or delegated company representative	
Economic Sector		ATECO Code 	
Work placement address	
Locality 	 post code 	
Telephone	 Fax 	
e-mail 	

Tutor
Academic/Training Tutor: 	 Tel.	
Company Tutor:	 Tel:	
Role of company reference person 	

Insurance policies:
Workplace injury INAIL position no. 		Foreign insurance policy	
Insurance company 		Third party liability no.	

Obligations concerning health and safety in the workplace (Legislative Decree no. 81/2008)

Training requested
Individual protection devices, if any
obligatory documentation to be attached to this project.

Description of the personalized training path

Objectives of the training period

Activities 

Expected results

Competences/skills and knowledge to be acquired

Assessment method

Other

How the activities included in the personalized training project are to be carried out
Area in which trainee is to be inserted	
Time of access to the premises (hours per day)	
Duration of training period (total no. hours) 	
Duration: from 	 to 	
Other

Place	Date 	
Place	date 	
Place	date 	

School/Training Institute	 Signature 
Employer			Signature
Trainee  *			Signature

*if minor		 
Person exercising parental authority	Signature

Place	date 	Signature of person exercising parental authority

Directive pursuant to Legislative decree no. 196/2003: the personal data provided in this document are handled for the purposes of registering the initiative using tools, including automated tools, used to memorize, manage and transmit data, and which are able to ensure the safety and confidentiality of the data.