Shetland Employability PathwayReferral Form

Referral Agency Details
Referring Agency
Agency Worker Name / Agency Worker Role
Address / Tel No: (Work)
Mobile: (Work)
Postcode / Email Address:
Participant Details:
Name / Date of Birth
Address / Home Phone
Mobile
Post Code / Email
NI Number / Current Nationality
Identified Gender / Place of Birth
Does the participant hold an active GIRFEC or WYFY?
Details of Benefits (please select all that are applicable)
If possible, please provide full details of the customer’s current claim(s). This is likely to increase their eligibility to receive support from the Shetland Employability Pathway.
Universal Credit / Employment and Support Allowance / Working Tax Credit
Job Seekers Allowance / Disability Living Allowance / Child Tax Credit
Education Maintenance Allowance / Personal Independence Payment / Childcare Element of WTC
Income Support / Housing Benefit / Carers Allowance
Other / Please Specify:
Any further details relating to benefits claims (i.e. any appeals/applications currently being processed)
Please select all applicable Barriers to Employment (see guidance at end of this form)
Unemployed / Low skilled / Long-term physical illness
Long-term unemployment / No work experience / Living in a jobless household
Substance related conditions / Criminal convictions / Living in a jobless household with dependent children
Primary carer of a child/children (under 18) or adult / Disabled / Living in a single adult household with dependent children
Primary Carer of elderly person / Asylum seeker / Migrant, people with a foreign background, minorities
Mental health issues / Refugee / Homeless or affected by housing exclusion
Armed Forces Veteran / Looked after young person / Poor accessibility to services
Above 54 years of age / Rural Areas (1) / Rural Areas (2)
Please provide any supporting information to explain why you believe the customer to have these barriers. Evidence of barriers will be required i.e. – official letter/copy of benefits and Bank statements.
Additional Information
Length of time since the participant last worked (years and months)
Description on progress made with referring agency (please detail any relevant information):
Please detail below any additional information eg personality, past history, home and family life, emotional support needs, goals for the future and any other relevant information:
Justification as to why the Participant has been referred:
Details of all other agencies involved with the Participant
Agency / Name / Contact Numbers

Participant: I consent to participate in the Shetland Employability Pathway and that my personal information can be shared appropriately between the organisations supporting me.

Signature: ...... Date:......

Signature of Representative from Referring Agency: ...... Date: ......

The Shetland Islands Council is registered as a Data Controller in terms of the Data Protection Act 1998. The information provided by you will beused for the purpose of your participation in the Shetland Employability Pathway, and for no other purpose. Your information will not be shared with organisationsoutwith the Shetland Employability Pathway or used for any other purposes, without your explicit consent.

Guidance on Barriers to Employment
A participant is eligible for the pathway if they are unemployed and have 2 or more barriers to employment, with exception to participants who are in long-term unemployment (see below).
Definitions of Barriers
Long Term Unemployment:
A participant is considered in long term unemployment if they are under 25 and have been out of work for 6 months or more, or if they are over 25 and have been out of work for 1 year or more.
Please note. If a participant is long term unemployed, they do not need to have any further barriers to employment to access support from the Pathway.
Low Skilled:
Highest level of qualification is ISCED Level 1-2 which include the following: no qualifications, National 1-4, Access 1-3, General/Foundation Standard Grade, Intermediate 1, NC or any other SCQF Level 1-4 qualification.
Criminal Convictions:
Any crime that an individual has been convicted of that has not been spent or is exempt from being spent.
Homeless or affected by housing exclusion:
Includes those in temporary/unstable accommodation
Rural Areas (1):
Participants who reside in Lerwick
Rural Areas (2):
Participants who reside in areas outside Lerwick

Referral_Form_v4_Oct 2017