Self Referral Form - Employ Merton

EMPLOY MERTON

Employ Merton is a Merton Council employability service, here to support you to gain, retain and progress in work.

How we do this depends on your individual circumstances and what you want to achieve. We work for you!

We have exclusive training, work trials, work experience and job opportunities. We can support with some travel, lunch and childcare expenses. There are so many ways that we can support you to earn a good living and step closer to the financial future you deserve.

So please complete this referral form in full, sign and return our disclosure form with proof of ID.

You’ll hear from us very shortly.

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* 1. About you:

Name

Contact number

Email Address

Date of birth

Gender

Borough you live in:

Address

post code

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* 2. National Insurance number

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* 3. Gender

Male

Female

non-binary

Prefer not to say

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* 4. How would you describe your ethnicity?

If you ethnic identity is not described above, please describe it here:

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* 5. While we can support any Merton resident, most of our funding is to support residents who haven’t been actively looking for work in the last 2 weeks. Please confirm if the following statement is true or false.

I haven’t been job hunting in the last 2 weeks

True

False

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* 6. What is your current employment status

Working fulltime

Working part-time

Currently unemployed

Do not have the right to work in the uk

Self-employed

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* 7. Please select all the benefits you are receiving; you will be asked to provide proof of this. if you are not on any of these benefits please select 'None'

Job Seekers Allowance (JSA)

Universal Credit (UC)

Personal independence payment (PIP)

Employment and Support Allowance (ESA)

None

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* 8. Please provide proof of all of the benefits you are receiving - a picture of your Job Centre journal is acceptable

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* 9. Please tell us the last time you were in Education Employment and Training in format of DD/MM/YYYY

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* 10. Please attach a copy of your CV if you have one.

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* 11. What has made it difficult for you get into work or change your job?
Please put a yes/no to the suggestions listed below and feel free to provide further details.

Confidence

Mental wellbeing, i.e. stress, anxiety, feeling worried

Physical wellbeing/medical condition

Caring responsibilities

Lack of work experience

Don't have the right qualifications

Applying but not getting interviews

I have additional learning needs

I have a physical disability

I am homeless/I live in temporary accommodation

Am worried I will be worse off if working

Not sure how to start

Other

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* 12. Which of the following documents are you able to provide to prove you have the right to work?

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

I have the right to work but don't have any documents

I do not have the right to work in the UK

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* 13. Please upload a copy your proof of right to work documents.

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* 14. Are you at risk of harm from anyone or at risk of harm if you visit any area?

Yes

If you answered yes, please provide some details to support us to keep you safe.

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* 15. Are you living in temporary accommodation or are you homeless?This means that you do not have a stable home address or are living somewhere on a temporary basis

Yes

prefer not to say

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* 16. Do you live in a household with children aged 16 or under?

Yes

Self Referral Form - Employ Merton

EMPLOY MERTON

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* 1. About you:

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* 2. National Insurance number

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* 3. Gender

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* 4. How would you describe your ethnicity?

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* 5. While we can support any Merton resident, most of our funding is to support residents who haven’t been actively looking for work in the last 2 weeks. Please confirm if the following statement is true or false.

I haven’t been job hunting in the last 2 weeks

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* 6. What is your current employment status

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* 7. Please select all the benefits you are receiving; you will be asked to provide proof of this. if you are not on any of these benefits please select 'None'

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* 8. Please provide proof of all of the benefits you are receiving - a picture of your Job Centre journal is acceptable

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* 9. Please tell us the last time you were in Education Employment and Training in format of DD/MM/YYYY

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* 10. Please attach a copy of your CV if you have one.

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* 11. What has made it difficult for you get into work or change your job?
Please put a yes/no to the suggestions listed below and feel free to provide further details.

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* 12. Which of the following documents are you able to provide to prove you have the right to work?

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* 13. Please upload a copy your proof of right to work documents.

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* 14. Are you at risk of harm from anyone or at risk of harm if you visit any area?

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* 15. Are you living in temporary accommodation or are you homeless?This means that you do not have a stable home address or are living somewhere on a temporary basis

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* 16. Do you live in a household with children aged 16 or under?

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* 17. Number of adults in your household who work fulltime

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* 18. Number of adults in your household who work part-time

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* 19. Please tell us what opportunity you are interested in or the type of support you would like us to provide you

Self Referral Form - Employ Merton

EMPLOY MERTON

Question Title

* 1. About you:

Question Title

* 2. National Insurance number

Question Title

* 3. Gender

Question Title

* 4. How would you describe your ethnicity?

Question Title

* 5. While we can support any Merton resident, most of our funding is to support residents who haven’t been actively looking for work in the last 2 weeks. Please confirm if the following statement is true or false.I haven’t been job hunting in the last 2 weeks

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* 6. What is your current employment status

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* 7. Please select all the benefits you are receiving; you will be asked to provide proof of this. if you are not on any of these benefits please select 'None'

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* 8. Please provide proof of all of the benefits you are receiving - a picture of your Job Centre journal is acceptable

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* 9. Please tell us the last time you were in Education Employment and Training in format of DD/MM/YYYY

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* 10. Please attach a copy of your CV if you have one.

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* 11. What has made it difficult for you get into work or change your job? Please put a yes/no to the suggestions listed below and feel free to provide further details.

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* 12. Which of the following documents are you able to provide to prove you have the right to work?

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* 13. Please upload a copy your proof of right to work documents.

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* 14. Are you at risk of harm from anyone or at risk of harm if you visit any area?

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* 15. Are you living in temporary accommodation or are you homeless?This means that you do not have a stable home address or are living somewhere on a temporary basis

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* 16. Do you live in a household with children aged 16 or under?

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* 17. Number of adults in your household who work fulltime

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* 18. Number of adults in your household who work part-time

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* 19. Please tell us what opportunity you are interested in or the type of support you would like us to provide you

* 5. While we can support any Merton resident, most of our funding is to support residents who haven’t been actively looking for work in the last 2 weeks. Please confirm if the following statement is true or false.

I haven’t been job hunting in the last 2 weeks

* 11. What has made it difficult for you get into work or change your job?
Please put a yes/no to the suggestions listed below and feel free to provide further details.