/ Issued 06/02/2018
Form owner:Get Moving Manager
Approved by:National Business Development Manager

Get Moving Referral Form

CLIENT INFORMATION
Job Seeker Name / JSID
JS Phone Number / Provider: / ☐jobactive
☐DES
☐TTW
☐Other
Referring Consultant
Referring Office/ Location / Contact Number
ELIGIBILITY CRITERIA
Referred participantsmust meet eligibility criteria. Please answer all questions below.
☐Yes ☐No / Is this Young Person aged between 18 and 24 (inclusive) years old?
☐Yes ☐No / Does the Young Person live in the Selected Region? Tick relevant box below:
☐Adelaide North
☐North West Country, SA
☐Hunter (excluding Newcastle), NSW
☐North Western Melbourne, VIC
☐Barwon, VIC
☐Yes ☐No / Is the Young Person willing to relocate for employment (min. 2 hrs travel away from home)?
Relocation preference?
(New location name)
☐Yes ☐No / Has this referral been discussed with the Young Person?
Eligible for Subsidies (tick all that apply) / ☐Youth Bonus ☐LTU and Indigenous ☐Parents ☐RATTUAJ ☐DES

Which issues are impacting upon the young person’s ability to find work in their current location?

☐ / Vocational (lack of skills or work experience…) / ☐ / Financial
☐ / Mental health / ☐ / Family and relationships
☐ / Homelessness, or risk of / ☐ / Transport (e.g. obtaining a drivers licence)
☐ / Anger management / ☐ / Lacking motivation
☐ / Grief/loss / ☐ / Lacking self esteem and confidence
☐ / Drugs or alcohol / ☐ / Domestic violence
☐ / Other, please specify:

Please note:

Get Moving is a programsuitable for job seekers with a capacity to work, or job ready job seekers. It is designed to support young people who are willing to relocate for full time employment to a new location, minimum 2 hours travel away from their home location.Before proceeding with a referral of a young person with poor history of attendance to Employment Service Provider appointments,please speak toGet Moving Mentor.

PLEASE RETURN THIS COMPLETED FORM TO:
Occupation: / Get Moving Mentor
Email: /

Get Moving Mentor in your region will contact you and the young person within two business days to arrange a meeting and complete an assessment to determine suitability for the program.

Uncontrolled if printed

ID: Disability Employment Services, jobactive, Youth Services, Get Moving-Form-1489-Version:7.0 / Page 1 of 2