15. Employment Status Full Time (24 Hours or Part Time (23 Hours or Self Employed more per week) less per week) Full Time Student Government Training or Long Term Sickness or Work Programme Disabled Unemployed: Seeking Unemployed: Not Retired Work Seeking Work Other: Please Specify 16. Unemployment Period (If Stated in Section 15.) 1 3 Months 3 6 Months 6 12 Months – – – 1 2 Years 2- 5 Years Over 5 Years – 17. Income Range £0 - £6000 £6000 - £12,000 £12,000 - £20,000 £20,000 - £30,000 £30,000+ Over £300 Per Week 18. Housing Status Not Known Any other Temporary Approved Probation Accommodation Hostel Bed & Breakfast or Direct Access Health Children’s Home Foster Care Foyer Home Office Asylum Hospital Support Housing Association: Housing Association: Housing for Older General Needs Tenancy People Living With Family Living With Friends Local Authority General Needs Tenancy Mobile Home or Other Owner Occupation Caravan Owner Occupation: Low Placed Prison Cost Home Private Sector: Leasing Private Sector: Tenancy Residential Care Home Rough Sleeper Short Life Housing Supported Housing Tied Housing or Rented Refuge Women’s with Job 19. Household Type One Person- Female One Person- Male Couple with Dependent Applicant Applicant Children One Person- (M) With One Person- (F) With All Other Households Dependent Children Dependent Children
15. Employment Status Full Time (24 Hours or more per week) Part Time (23 Hours or less per week) Self Employed Full Time Student Government Training or Work Programme Long Term Sickness or Disabled Unemployed: Seeking Work Unemployed: Not Seeking Work Retired Other: Please Specify 16. Unemployment Period (If Stated in Section 15.) 1 – 3 Months 3 – 6 Months 6 – 12 Months 1 – 2 Years 2- 5 Years Over 5 Years 17. Income Range £0 - £6000 £6000 - £12,000 £12,000 - £20,000 £20,000 - £30,000 £30,000+ Over £300 Per Week 18. Housing Status Not Known Any other Temporary Accommodation Approved Probation Hostel Bed & Breakfast Children’s Home or Foster Care Direct Access Health Foyer Home Office Asylum Support Hospital Housing Association: General Needs Housing Association: Tenancy Housing for Older People Living With Family Living With Friends Local Authority General Needs Tenancy Mobile Home or Caravan Other Owner Occupation Owner Occupation: Low Cost Home Placed Prison Private Sector: Leasing Private Sector: Tenancy Residential Care Home Rough Sleeper Short Life Housing Supported Housing Tied Housing or Rented with Job Women’s Refuge 19. Household Type One Person- Female Applicant One Person- Male Applicant Couple with Dependent Children One Person- (M) With Dependent Children One Person- (F) With Dependent Children All Other Households
Floating%20Support%20Referral.docx