Employ Yourself 2022

Employ Yourself
Delivered by Tree Shepherd in Partnership with Paddington Development Trust

Thank you for registering an interest in the Employ Yourself Programme. This course is for people who are unemployed or economically inactive. The course will involve business mentoring and advice, networking, and a 6-week course. We will meet with you before enrolling on the programme to answer any queries and to see if this programme will work for you.

Please be aware that the questions on this form are mandatory so all questions with a * will need to be completed. This is a requirement from our funders, which enables us to deliver this programme for free. If you have any issues completing the form please contact - shaun@treeshepherd.org.uk and rhian@treeshepherd.org.uk

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* 1. First Name

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* 2. Surname

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* 3. Address

Address

Address 2

City/Town

Borough

ZIP/Postal Code

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* 4. Email Address

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* 5. Mobile Number

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* 6. NI Number

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* 7. UTR Number (if you have one)

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* 8. What is your Gender? Please tick a box

Female

Male

Transgender

Prefer not to say

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* 9. What is your age group? Please tick a box

18-24

25-34

35-44

45-54

55-64

65 and over

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* 10. What is your Ethnicity? Please tick a box

English/Welsh/Scottish/Northern Irish/British White Irish

White Gypsy or Irish Traveller

Any other White beckground

Mixed White & Black Caribbean

Mixed White & Black African

Mixed White & Asian

Mixed/Multiple Ethnic Group - Other

Asian/ Asian UK Indian

Asian/ Asian UK Pakistan

Asian/ Asian UK Bangladeshi

Asian/ Asian UK Chinese

Asian/Asian British - Other

Asian/ Asian UK Anu other backgroud

Black/African/Black British – African

Black/Caribbean/Black British – Caribbean

Black/Caribbean/Black British - Other

Arab

Any Other Ethnic Group

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* 11. What is your Residency Status? Please tick all that apply

I am a UK citizen or have the right to abode in the uk

Refugee

Asylum Seeker

Indefinite Leave to Enter/Remain

Exceptional Leave to Enter/Remain

Discretionary Leave to Enter/Remain

Leave to enter as a student

Leave to enter to accompany spouse

Leave to enter to accompany parent

Work permit holder

Humanitarian Protection

Other

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* 12. Do you have a Disability/Learning Difficulty/Health Problem?

Yes

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* 13. If you asnwered Yes to the above question. Please choose from the following all that apply to you, otherwise go to the next question

Moderate Learning Difficulty

Severe Learning Difficulty

Dyslexia

Dyscalculia

Other Specific Learning Difficulty

Autism spectrum disorder

Multiple Learning Difficulties

Other

Visual Impairment

Hearing Impairment

Disability Affecting Mobility

Other Physical Disability

Other Medical Condition (For Example Epilepsy, Asthma, Diabetes)

Emotional/Behavioural Difficulties

Mental Health difficulty

Temporary Disability After Illness (For Example Post-Viral) or Accident

Profound Complex Disabilities

Asperger’s syndrome

Multiple Disabilities

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* 14. Is your household income below £25000?

Yes

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* 15. How many dependent Children do you have? (enter 0(zero) if you have none)

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* 16. What is your Highest level of qualification or education? Please tick a box

Entry Level

Other qualification below Level 1

Level 1: Fewer than 5 GCSEs (A-C)

Full Level 2: At least 5 GCSEs (A-C)

Level 3: (NVQ Level 3, BTEC National Diploma, Access to Higher Education)

Full Level 3: 4+ 'AS' Levels or 2+ 'A' Levels

Level 4 - Cert. of HE/HNC

Level 5 - HND / Foundation degree

Level 6 - BA/Bsc Degree

Level 7 and above - Post Graduate

Other qualifications, level unknown

No qualifications

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* 17. Employment Status? Please tick a box (Please note that the course is funded for people who are unemployed or economically inactive, so if you tick employed or self employed we may not be able to enrol you on to the course)

I am Self-Employed

I am in paid employment - part-time

I am in paid employment - full-time

I am registered unemployed with Job Centre Plus (Looking for work)

I am unemployed but not registered with Job Centre Plus (Looking for work)

I am registered economically inactive with Job Centre Plus (Not looking for work)

I am economically inactive but not registered with the Job Centre Plus (Not looking for work)

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* 18. Which Benefits do you receive? Please tick a box

No unemployment benefits received

Job Seekers Allowance (JSA)

Other benefit other than JSA, Universal Credit or ESA (WRAG)

Universal Credit

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* 19. Length of unemployment? Please tick a box

I am employed (including self-employment)

I have been unemployed for less than 6 month

I have been unemployed for 6-12 months

I have been unemployed for 12-24 months

I have been unemployed for 36 months or more

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* 20. How did you hearabout us?

Google

Facebook

Twitter

Instagram

Friends

leaflet

We are pop up

Ugli

Other

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* 21.
Declaration:

I confirm that the information that I have provided is correct to the best of my knowledge and authorise Tree Shepherd and its partners to use my information for the above purposes. Your information will be securely destroyed after it is no longer required for these purposes.

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* 22. Privacy Notice – How We Use Your Personal Information

This privacy notice is issued by Tree Shepherd Limited. It is to inform you how their personal information will be used by Tree Shepherd Limited and its partners For the purposes of relevant data protection legislation, Tree Shepherd Limited is the data controller for personal data processed

The information supplied on this form will be retained securely by Tree Shepherd Limited and its partners

The personal information provided is used by Tree Shepherd Limited and its partners to create a personal business recorded within Tree Shepherd’s secure dataset. The information is used to support your participation on Start Your own Enterprise Course and for the provision of ongoing business support. The data may also be used for data analysis and research. This is to ensure the provision of high quality, inclusive, relevant service which supports achievement and progression, regardless of individual background, skills, knowledge, experience and support needs.

The information provided may be shared in anonymised form with third parties for businesses, training, (self) employment and well-being related purposes including for research. You will not be individually identified without prior consent. Your information will be securely destroyed after it is no longer required for these purposes.

At all times, sharing of your information will only take place where the law allows it and the sharing is in compliance with data protection legislation. You may change your preferences at any time.

Tree Shepherd Limited and its partners may use your contact details to let you know about business development opportunities, including clinics, events, trading, networking and business support opportunities.

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* 23. Further information about our data protection policy and procedures, including use of and access to your personal data are available at: info@treeshepherd.org.uk

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* 24. There are occasions when photographs of activities are taken for publicity and marketing purposes, and you can agree for your image to be taken by ticking the following box: □

Please tick

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* 25. OFFICIAL USE ONLY

Proof of Benefit received

Proof of Income received

Employ Yourself 2022

Employ Yourself Delivered by Tree Shepherd in Partnership with Paddington Development Trust

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* 1. First Name

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* 2. Surname

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* 3. Address

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* 4. Email Address

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* 5. Mobile Number

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* 6. NI Number

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* 7. UTR Number (if you have one)

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* 8. What is your Gender? Please tick a box

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* 9. What is your age group? Please tick a box

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* 10. What is your Ethnicity? Please tick a box

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* 11. What is your Residency Status? Please tick all that apply

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* 12. Do you have a Disability/Learning Difficulty/Health Problem?

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* 13. If you asnwered Yes to the above question. Please choose from the following all that apply to you, otherwise go to the next question

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* 14. Is your household income below £25000?

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* 15. How many dependent Children do you have? (enter 0(zero) if you have none)

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* 16. What is your Highest level of qualification or education? Please tick a box

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* 17. Employment Status? Please tick a box (Please note that the course is funded for people who are unemployed or economically inactive, so if you tick employed or self employed we may not be able to enrol you on to the course)

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* 18. Which Benefits do you receive? Please tick a box

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* 19. Length of unemployment? Please tick a box

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* 20. How did you hearabout us?

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* 21. Declaration: I confirm that the information that I have provided is correct to the best of my knowledge and authorise Tree Shepherd and its partners to use my information for the above purposes. Your information will be securely destroyed after it is no longer required for these purposes.

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* 23. Further information about our data protection policy and procedures, including use of and access to your personal data are available at: info@treeshepherd.org.uk

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* 24. There are occasions when photographs of activities are taken for publicity and marketing purposes, and you can agree for your image to be taken by ticking the following box: □

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* 25. OFFICIAL USE ONLY

Employ Yourself
Delivered by Tree Shepherd in Partnership with Paddington Development Trust

* 21.
Declaration:

I confirm that the information that I have provided is correct to the best of my knowledge and authorise Tree Shepherd and its partners to use my information for the above purposes. Your information will be securely destroyed after it is no longer required for these purposes.