Care Leavers Jobs Program Referral Form

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Who has told you about this project or who is making this referal? If you are the candidate and completing this yourself please go to the next section "About the Candidate..."

Name

First

Last

Phone

Brief description who you are and circumstances

About the Candidate...

Candidate's Name *

First

Last

Are you in Care or a Care Leaver? *

Yes
No
Not sure

Please tell us about where you live *

Bed and breakfast
Emergency accommodation
Supported accommodation (Sharing)
Supported accommodation (on own)
Own tenancy (Social Housing)
Own tenancy (Private Sector)
Children's Home
Foster Home
Sofa Surfing
Staying with family
Somewhere else

Candidate's Phone Number *

Address *

Email *

Gender *

Male
Female
Other

DOB *

If you are not sure what to write in these next couple of boxes - that's ok. Just write what you can.

Please tell us here what you would like to do in in the future. Please go into as little or as much detail as you want.

Please tell us about any issues that you are experiencing at the moment that you may need help with.

About how we use your information

We will do all we can and will use your data to link you up with others including businesses that can offer work experience, jobs and further training and mentoring. We will also work with the DWP and other agencies including Social Care and District and City Councils to help you achieve your dreams. Here is our Data Protection Policy https://normangallowayhomes.co.uk/wp-content/uploads/2021/09/GDPR-Norman-Galloway-Homes.pdf

PLEASE INDICATE IF WE CAN SHARE YOUR INFORMATION FOR THIS PURPOSE *

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

Phone

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Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

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Email *