WISH initial contact and information survey

Welcome to Horsham WISH.

Completing this survey will allow WISH to offer you suitable services, support and information that is most relevant to you and your needs.

Once completed we will be in touch with you shortly.

If you need additional support to complete this please call 07783 222956.

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* 1. What is your name?

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* 2. What is the best telephone number to contact you on?

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* 3. What is your email address?

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* 4. Where do you live? (just village or town, not address)

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* 5. What benefit are you on?

Universal Credit

JSA

ESA

Other

No benefit

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* 6. Your current situation.

Haven't worked for under three months

Haven't worked for three - six months

Haven't worked for six - twelve months

Haven't worked for one - two years

Haven't worked for two - three years

Haven't worked for over three years +

I have been furloughed

I am working but need more work, or wish to change job

Other (please specify)

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* 7. Do you have a disability / health condition? (will be discussed at first appointment)

Yes

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* 8. Do you have a criminal record?

Yes

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* 9. What kind of work are you looking for? (tick all relevant)

Anything part-time

Anything full-time

Retail

Office - customer service / call centre

Office - administration

Factory, Manufacturing or Warehouse

IT / Technology

Working outdoors

Home working

Driving

Night-shift work

Cleaning

Sales

Construction - labouring

Construction - skilled trade

Management role

Other (please specify)

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* 10. What assistance would you like to receive? (tick all relevant)

Applications

Interview skills

Online networking / social media

Jobsites and online recruitment pages

Self-confidence and motivation

All of the above

Other (please specify)