Referral Form

Towards Employment Project

Towards Employment is a Merton Council Project that supports any Merton resident, of any age into work, apprenticeships and training opportunities.

We want to help residents to earn a good living while learning and achieving positive outcomes which includes supporting them to upskill and improve their wellbeing.

Our support includes, interview preparation, introductions to employers and training providers, paid participation for training and work experience. We also help our cohort to think about the decisions they can make around taking part in activities that may put them at risk. We also help them to navigate and deal with some of the difficult aspects that can be experienced in life.

Please provide all of the information requested on this form as we will not be able to accept incomplete referrals.

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* 1. Referrer Details

Name

Job title

Agency/ Organisation

Phone Number

Email Address

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* 2. Opportunity being referred for:

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* 3. Candidate details

Name

Contact number

Email Address

Date of birth

Address and Postal Code

National Insurance number

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* 4. Gender

Male

Female

non-binary

Prefer not to say

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* 5. What is the candidates ethnicity?

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* 6. Are they in receipt of benefits? if yes, please state which type

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* 7. Next of kin - Contact details

Name

number

Relationship to the candidate

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* 8. What was the last secondary school that they
attended?

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* 9. What is the candidates highest educational attainment?

No qualifications

up to Level 1 (function skills / GCSE D-G or 1-3 equivalent)

up to Level 2 (GCSE A*–C or 4-9 equivalent)

up to Level 3 (A level/access to higher education diploma/ advanced apprenticeship)

up to Level 4 (first year of a Bachelor's Degree programme equivalent)

up to Level 5 or above (foundation degree equivalent or above)

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* 10. Which statement best describes the person’s Labour Market status?

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* 11. At this current stage, on a scale of 1 - 5, how confident are they in finding employment without support? (1 being not at all and 5 being extremely confident)

not confident

a little confident

quite confident

very confident

extremely confident

not confident

a little confident

quite confident

very confident

extremely confident

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* 12. What has made it difficult for them to get a job?
Please put a yes/no to the suggestions listed below and feel free to provide further details.

Confidence

Mental Health

Caring responsibilities

being unsure of what's available based on their current circumstances

Other reasoning (please give details)

Unsure

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* 13. Does the candidate have the right to reside/work in the UK and able to provide proof of the following (please select all that apply):

Bank account

NI number

Passport/Birth certificate/residency permit

Photo ID (residency permit/driver's license/passport)

2x proofs of address (dated within the last 3 months)

Has right to work in the UK but does not have any supporting documents as proof

Does not have the right to work in the UK

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* 14. Do they have a driver's license?

Yes

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* 15. Do they have a CSCS card?

Yes

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* 16. Are there any known risks to or from this individual towards any individuals or cohorts?

Yes

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* 17. If yes, please provide further details; including any risk management plan and specific geographical areas of risk

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* 18. Is the candidate homeless or at risk of homelessness? - This means they do not have a stable home address or are living somewhere on a temporary basis

Yes

prefer not to say

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* 19. is the candidate living in a single adult household with dependent children? (are they living alone with dependent children i.e are they a lone parent?

Yes

prefer not to say

Referral Form

Towards Employment Project

Question Title

* 1. Referrer Details

Question Title

* 2. Opportunity being referred for:

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* 3. Candidate details

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* 4. Gender

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* 5. What is the candidates ethnicity?

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* 6. Are they in receipt of benefits? if yes, please state which type

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* 7. Next of kin - Contact details

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* 8. What was the last secondary school that theyattended?

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* 9. What is the candidates highest educational attainment?

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* 10. Which statement best describes the person’s Labour Market status?

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* 11. At this current stage, on a scale of 1 - 5, how confident are they in finding employment without support? (1 being not at all and 5 being extremely confident)

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* 12. What has made it difficult for them to get a job? Please put a yes/no to the suggestions listed below and feel free to provide further details.

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* 13. Does the candidate have the right to reside/work in the UK and able to provide proof of the following (please select all that apply):

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* 14. Do they have a driver's license?

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* 15. Do they have a CSCS card?

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* 16. Are there any known risks to or from this individual towards any individuals or cohorts?

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* 17. If yes, please provide further details; including any risk management plan and specific geographical areas of risk

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* 18. Is the candidate homeless or at risk of homelessness? - This means they do not have a stable home address or are living somewhere on a temporary basis

Question Title

* 19. is the candidate living in a single adult household with dependent children? (are they living alone with dependent children i.e are they a lone parent?

* 8. What was the last secondary school that they
attended?

* 12. What has made it difficult for them to get a job?
Please put a yes/no to the suggestions listed below and feel free to provide further details.