Customer Consent Form / Document Control
Reference: REC BM2
Issue No: 7
Issue Date: 16/05/2012
Page: 1 of 3

Customer name……………………………………………………………. (Please print name in full)

Section 1 Employment Programmes – Consent to share information

The Interserve Working Futures Partnership is working with Jobcentre Plus customers on behalf of the Department for Work and Pensions (DWP) to help these customers to increase their skills to help them find and keep work. The Interserve Working Futures Partnership may claim a payment from DWP for every Jobcentre Plus customer who finds work while or after participating in a programme.

To claim a payment from DWP, The Interserve Working Futures Partnership may need to confirm details of your employment.

To validate these claims DWP may need to confirm details of your employment. Where appropriate, this may involve confirming details with each of your employers.

To achieve this, The Interserve Working Futures Partnership, DWP and your future employers need your consent to share information about you as follows:

Stage 1: The Interserve Working Futures Partnership will give your name and national insurance number to your future employer. We may also share your CV with potential employers via standard e-mail.

Stage 2: Your employers will use your name and national insurance number to identify you, so that they can confirm to The Interserve Working Futures Partnership some or all of the following information:

§  The date you began each period of your employment

§  Whether your employment is continuing

§  If not continuing, the date each period of your employment ended

§  Whether you were employed during a specific period

§  The number of hours you worked each week

§  The amount of your earnings each week

§  Your employee number or other unique identifier

Stage 3: To validate payment claims from The Interserve Working Futures Partnership, DWP may contact your employer using your name and national insurance number to ask for the information listed at stage 2. It will use this information to:

§  Check if the information given to it by The BEST Partnership is correct

§  Evaluate the programme

DWP will store your information securely for audit purposes. If you do not give consent, this will not affect your entitlement to participate in the programme, or any job offer or employment obtained. You can write to The BEST Partnership at any time to withdraw your consent and this will not affect your placement on the programme or any employment or offer of employment made.

I give consent do not give consent for The Interserve Working Futures Partnership, my future employer and DWP to share information as described in stages 1 to 3 above.

I confirm that:

I have read the information above and understand why this information sharing is needed and how this information will be used.

I understand that:

If I am in receipt of any benefits, my entitlement to these benefits will not depend on whether I choose to give consent or not.

My placement on any programme with The Interserve Working Futures Partnership and any employment or future offer of employment will not depend on whether I choose to give consent or not.

I can withdraw my consent at any time by writing to The Interserve Working Futures Partnership

Section 2 Employment Programmes – Information Disclosure

Interserve Working Futures and its partners, in accordance with the Data Protection Act 1998, collect and use information obtained from customers, DWP and Jobcentre Plus. This may be stored electronically and/or paper based. We record and retain information for all customers who access our programmes. This includes customer names, addresses, National Insurance Numbers, benefits received and information relevant to the aim of the programme.

The purpose of collecting this information is for record keeping, monitoring the effectiveness of our service and supporting customers to gain skills and move into sustainable employment. We may give information to other organisations as the law allows, for example to safeguard against crime.

It is your own responsibility when in our branches to protect your own personal information. This includes using telephones, computers, printers and faxes.

Section 3 Employment Programmes – Welcome Pack

On joining the programme with Interserve Working Futures you will be issued with a welcome pack which covers the topics below to support you in the time that you spend with us:

·  Welcome Statement

·  The Work Programme

·  Code of Conduct

·  Travel Costs

·  Childcare

·  Equality and Diversity

·  Grievance Procedure

·  Safeguarding

·  Emergency Procedures

·  Doubt and Sanctions

You should also be issued with the following documents:

·  MKT8000 explaining the European Social Funding for your programme

·  Customer promise part 2

·  Computer Internet Guidelines

Section 4 Employment Programmes – Travel Expenses

During your allocated time on the Work Programme with the Interserve Working Futures Partnership, we will refund your travel expenses for appointments with us.

If you travel by public transport, we will refund, on production of a ticket, the cost of your return fare or the cost of a Day Ticket (for example Day Rover), whichever is the cheaper.

If you choose to travel by car, we will pay you at 30p per mile or the equivalent of the cheapest public transport rate, whichever is the lesser amount.

If you do not incur any travel costs or do not wish to claim travel expenses please indicate in the appropriate section below.

I wish to claim travel expenses for my Work Programme appointments
Travel from
Travel to
Method of travel
Daily cost / £ : / Code: (see below)

CODES:

R = Return bus/train fare D = Day Ticket e.g. Day Rover

M = Mileage at 30p per mile C = Cheapest rate

I do not wish to claim travel expenses for my Work Programme appointments
Reason

I declare that the travel information given above is correct and I will report any changes to the Interserve Working Futures Partnership.

I also confirm that I have read and completed the consent form in section 1, read and understood the information disclosure in section 2 and I have received all the documents listed in part 3.

Signature ………………………………………………………………………….

Date …………………………

This project is part-financed by the European Union.