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We Work For Everyone Bristol Logo
  • Home
  • How WE work
  • Opportunities
  • Join programme
  • About
    • About us
    • Meet the team
    • For Employers
  • News

1Referral
2Participant Details
3About You
4Equality
5Privacy

Referral Source

Who is completing this form?
What is your relationship to the participant?

Participant Details

Date of Birth

About You

Your right to live and work in the UK

Do you have right to work in the UK?

Please bring in your birth certificate or passport to your initial meeting. If you’re not British, please bring in your proof of ‘right to work’ in UK, such as visa, biometric identity card or EUSS code.

Your Employment Status

What is your employment status (on joining)?
Details of your employment
Please select one option that best describes your current employment status:

Your Benefits

Are you receiving any benefits or financial support?
Please select all of the benefits you are receiving:
How long have you been receiving Universal Credit?
Do you have a Job Centre Plus worker? (Work Coach / Disability Employment Advisor)
Are you in a Limited Capability for Work (LCW) or Limited Capability for Work and Work Related Activities (LCWRA) group?The Work Capability Assessment is used to decide whether or not you are fit for work for ESA and Universal Credit'.

Your entitlement to benefits could be affected by decisions you take, or changes and progress you make while or after engaging with the We Work for Everyone programme.

It is vital to inform all relevant agencies about any changes to your work hours and pay, even if you think your benefits will not be affected. It is your responsibility to inform all relevant agencies of changes to your circumstances, although your Navigator can support you with this process if needed.

Your Education

What is your highest level of educational attainment (on joining)?
Is English your first or main language?

Household information

Are you from a jobless household?‘Jobless household’ refers to all household members irrespective of age (e.g. a young person living with retired grandparents would count as living in a jobless household)
Are you from a jobless household with a dependent child or children?‘Jobless household’ with dependent children’ is a sub category of ‘jobless household’, meaning that anyone falling into this category must also be recorded under jobless household. ‘Dependent child / children’ means individuals aged 0-17 years OR individuals aged 18-24 if economically inactive and living with at least one parent.
Are you a single parent / carer?‘Single adult household with dependent children’ includes only one adult (individual aged 18+) irrespective of their employment status.
Are you homeless?A person will be classed as being legally homeless if they:
  • have no home in the UK or anywhere else in the world;
  • have no home where they can live together with their immediate family;
  • can only stay where they are on a very temporary basis;
  • do not have permission to live where they are;
  • have been locked out of their home and are not allowed back;
  • cannot live at home because of violence or abuse or threats of violence or abuse which are likely to be carried out against them or someone else in their household;
  • it is not reasonable for them to stay in their home for any reason, for example, their home is in very poor condition; cannot afford to stay where they are.
Are you an ex-offender?Ex-offender: a person who has one or more previous criminal convictions. Ex-offenders will have completed all supervision and licence requirements.

Equality

Background

We want to make sure that our services are fair and provided to those who need them. The information you provide will be used to help us to plan your support. By answering these questions, you will help us improve what we do and make our services more accessible. If you do not wish to answer any questions below, please select ‘prefer not to answer’.

Disability

Would you class yourself as disabled?
Visually Impaired/ Blind
Hearing Impaired / Deaf
Mental Health Issues
Learning Difficulty
Autism Spectrum Disorder/Asperger’s
Other Physical Disability

Privacy

Obtaining/disclosing information(Required)
  • Have been informed and understand that the activity delivered by the provider named on this form is part-funded by the European Social Fund and have received leaflet ESF2020
  • Understand that this ESF Provision is voluntary.
  • Agree to participate in this ESF Provision.
  • Understand that WE Work for Everyone will store your basic personal information included on this form, to make referral to the Provider.
  • Understand that, if eligible, you will meet navigators to receive 1-2-1 support best tailored to you from our single menu of opportunities.
  • Understand that, our staff may refuse to support those who behave in a discriminatory, offensive, aggressive or disruptive manner.
  • Give consent for us to stay in touch with you to monitor your progress and provide support for up to 6 months from when you join a training programme or employment. You can choose any mode of communication you prefer – a phone call, SMS, Email or by post. You can opt out of staying in touch after 6 months.
Open EasyRead Participant Agreement
I have read and accept the Participant Agreement above(Required)
Your name(Required)
Date of Signing(Required)
If you are unable to use the signature box, leave it blank and we will help you at your first meeting.
This field is for validation purposes and should be left unchanged.

Contact us

Call: 0117 922 3330
Email: weworkforeveryone@bristol.gov.uk
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