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Referral survey
Registration For Referral
This form is to refer yourself (or your candidate ) to Action West London electrical fixing event, please remember that this process can take up to 5 days.
*
1.
Contact details
(Required.)
Full name
Address
Borough
City
Postcode
National insurance number
Email
Phone number
Date of Birth
Ethnicity
2.
What is your gender?
Female
Male
Other (specify)
3.
Are you an ex-offender ?
Yes
No
*
4.
Current employment status
(Required.)
Employed
Unemployed and receiving benefits
Unemployed and not receiving benefits
Education/training
*
5.
Do you have an interest in a career in electrical fixing ?
(Required.)
Yes
No
6.
Please confirm the advisor and contact details of your advisor?
Advisor name
Advisor email
*
7.
Which of the following valid form of right-to-work do you currently have?
(Required.)
Passport
Driving License
Birth certificate
Biometric Residency Card
Letter from job center/Universal Credit statement
Bank statement
Other (please specify)
*
8.
How would you like to be contacted?
(Required.)
Text
Called
Whats app
All
*
9.
What would you describe as your biggest barrier to finding employment?
(Required.)
CV
Interview skills
Confidence
Mental health
Ex-offence or offence
Other (please specify)
*
10.
What is your highest qualification ?
(Required.)
11.
Please upload CV if you have one..
Choose File
No file chosen
12.
How you hear about the event ?
Soical media post
Flyer
Council website
Newsletter
Council newsletter
AWL website
