Information
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Document No
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Learner Name
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Completed by
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Date completed
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Learner Name
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Date of Birth
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Dealer
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Date of last contact (training, review, observation)
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Reason for withdrwal
- Employment elsewhere within Motor Industry (no training)
- Employment elsewhere within Motor Industry (other provider)
- Employment outside Motor Industry
- Remaining with employer but ceasing training
- Going to full time education
- Unemployed as a result of dismissal
- Unemployed as result of resignation
- Moving area
- Long term sickness (does not intend to return)
- Made redundant
- Death
- Moved providers only - remained with company
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Full details of reason for withdrawal
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Details of what has been done to retain the learner
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Details of support given to learner
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Is the learner seeking a placement at another dealership
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Is there a vacancy at the dealership
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Assessor/Reviewer signature
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Manager signature
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Details why there is no Manager signature
