The Following Applicant Has Been Referred By: (If Self-Referring, Just Complete Part 1)

/ Learning & Skills
Get Set for Work
Application Form

If you are interested in joining the Get Set for Work course at The Platform, please complete and return to

The following applicant has been referred by: (if self-referring, just complete part 1)

Referrer name
Referral organisation
Email
Phone number

Part 1: Applicant details (to be completed by the applicant with support if needed)

Name / Sex
Address
Mobile / landline
Email
N.I. number
Date of Birth / Age
Benefits claimed
Education
School/College / Subjects / Grades/Passes
Previous Work Experience
Employer / Job role / Length of service (weeks; months; years)
Preferred Sector / Occupation
Sector/Occupation / Reason for this choice
First Choice
Second Choice
Do you have any physical health conditions, mental health issues or learning difficulties? Please tell us about these and any medication or support you have regarding these.
Please describe why you are interested in doing the course
Please provide the name & contact details of any support you may receive, such as a Key Worker/ Social Worker/ Carer
Name: / Phone Number:
I would describe my ethnic origin as: (Please circle) / White UK / White Irish / White Gypsy or Traveller / Any other white
Caribbean / African / Other black / Arab / Indian / Bangladeshi / Pakistani / Chinese
White and Black Caribbean / White & Black African / Other mixed background / Other / Please state:
My sexual orientation is: (Please circle) / Hetero-sexual / Lesbian or gay / Other / Prefer not to say
Do you consider yourself to be disabled? / Yes / No
I would describe my religion as:

I declare that the information on this form is true and complete and if any details change I will notify The Platform. In signing this form I agree to give permission for The Platform and other agencies that support me to shareinformation about me as it relates to my involvement in the catering project and give my consent for The Platform to process the above data in compliance with the Data Protection Act 1998 for the purposes set out above.

Signed / Date

Part 2 – To be completed by referrer

Name of applicant
Does the applicant meet the referral criteria? / Yes / No
Are there any support issues (e.g. drug or alcohol dependency, mental health) that may make it difficult for the applicant to participate on the course? If so what are they? What would need to be in place to enable them to attend?
Is the applicant ready to commit (punctual, good attendance, able to work with others) to the course?
Is the applicant motivated to attend their course?
Are you able to support the applicant through their time on the courseand if so, what support will you be able to offer?
Has the applicant been risk assessed? / Yes / No
Please provide details from the risk assessment relevant to working with the applicant on the course.
Is there any other information that The Platform staff should know about the applicant?

Referral agent’s declaration:

I declare that the information provided within this form by me and the above named applicant is true and complete to the best of my knowledge.

Signed / Date
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