Parent / Carer Name: D.O.B: Address: Contact No: Child’s Name: D.O.B: Are you unemployed? Yes/ No (please circle) 2) What benefits are you receiving? Benefit Yes / Benefit Yes /No No Jobseekers Allowance Carers Allowance Income Support Employment Support Allowance Incapacity Benefit Severe Disability Allowance Notes 3) What support would you like? Support Type Yes / Support Type Yes/No No An in work benefits calculation to give an Local education or training estimate of how better off you could be in opportunities? work? Careers Advice/ Help completing a CV? Work experience, Work Trials & Apprenticeship opportunities? Help looking for work? Local Volunteering Opportunities? Is anything else you’d like help with? 4) Support Worker Details: Name: Agency: Telephone No. E-mail: 5) Consent: I have been involved in the completion of this form: Yes No I consent to the Supporting Families Employment Advisor to contact me in relation to the Yes No information on this form: Sign: Print: Date: Please send completed form to Paul (Supporting Families Employment Advisor) 2nd Floor North, Tor Hill House, Castle Circus, Torquay TQ1 3DR.Telephone: 07825833258
Parent / Carer Name: D.O.B: Address: Contact No: Child’s Name: D.O.B: Are you unemployed? Yes/ No (please circle) 2) What benefits are you receiving? Benefit Yes / No Benefit Yes /No Jobseekers Allowance Carers Allowance Income Support Employment Support Allowance Incapacity Benefit Severe Disability Allowance Notes 3) What support would you like? Support Type Yes / No Support Type Yes/No An in work benefits calculation to give an estimate of how better off you could be in work? Local education or training opportunities? Careers Advice/ Help completing a CV? Work experience, Work Trials & Apprenticeship opportunities? Help looking for work? Local Volunteering Opportunities? Is anything else you’d like help with? 4) Support Worker Details: Name: Agency: Telephone No. E-mail: 5) Consent: I have been involved in the completion of this form: Yes No I consent to the Supporting Families Employment Advisor to contact me in relation to the information on this form: Yes No Sign: Print: Date: Please send completed form to Paul (Supporting Families Employment Advisor) 2nd Floor North, Tor Hill House, Castle Circus, Torquay TQ1 3DR.Telephone: 07825833258
sf-employment-leaflet-and-referral.docx