Employment Support Form

Are you contacting us about yourself? *

Yes

Do you have permission to make this referral? *

Yes

No - please do not proceed with this form if you don't have consent

What is your name? *

What are your contact details? *

What organisation do you work with? *

What is the client's name? *

What is the client's date of birth?

What is the client's contact details? *

What is the person’s home address? *

Which areas are they seeking support around? *

Which employment support are you referring this individual to?

Complex needs officer

Social Supermarket programme (men with complex barriers to employment)

General employment service

Name *

Address *

Telephone Number *

Which of the following best describes the individual? *

Update CV

Looking for volunteer opportunities

Need advice and guidance to find work

Looking for an Apprenticeship or work placement

Interview prep

Support around self-confidence

Which of the following best describes you? *

Update CV

Looking for volunteer opportunities

Need advice and guidance to find work

Looking for an Apprenticeship or work placement

Interview prep

Support around self-confidence

Language spoken * *

How would you describe your home?

Other (please state)

Please tick all of the following that apply to you

I am on the GM Working Well: Work and Health Programme

I am on the GM Working Well: Support Employment Services

I am on the GM Working Well: Individual Placement & Support In Primary Care

I am on the DWP Restart Programme

I am on the Job Seekers Allowance and the Universal Credit Intensive Work Search Regime

I am former Armed Forces

I consider myself disabled

How would you like us to contact you?

By phone

By email

By text

How did you hear about us?

Social media

Website

Member of Stockport Homes staff

Friend

Other - please specify below

If other, please let us know

I confirm that SKylight can email me with news. information and service updates.

I confirm that SKylight can contact me regarding news, information and service updates via post.

I can confirm that SKylight can call me regarding news, information and service updates.

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Consent for storing submitted data *

Yes, I give permission to store and process my data

Employment Support Form

Employment support form