Go4it Client enrolment form 2021

If something has a red star next to it it is required, if you do not know the answer or it doesn't apply please supply your initials in this field.
First name*
Middle Name
Last Name*
Title*
Surname at birth*
What course have you been referred to us for?*

SecurityCSCS (Health and Safety in Construction)Functional SkillsDigital SkillsRetail and HospitalitySIA Security Top UpOther
Date of Birth*

DayMonthYear
Date
Age*
Sex*
Please state how you identify
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years at current address*
Preferred contact number*
Email Address*
example@example.com
Alternative contact number in case of emergency
National Insurance Number*
Please upload a current photo of yourself (clear photo of your head and shoulders on a plain background; like a passport photo) *If using a mobile device please go to the button below.

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Alternatively if using a mobile device please click this button to allow access to your camera to take the photo.
Are you currently in employment?*

YesNo
When did you become unemployed?*
What would you class yourself as?

Economically inactive (Unable to work for medical reasons etc)Just UnemployedIn Education or Training
What benefits do you currently receive?*

Job Seekers AllowanceUniversal CreditWorking Tax CreditChild Tax CreditCarers or DisabilityChild BenefitNone
Do you have a Disability?*

YesNo
If Yes, please provide further details
Do you have a Learning Difficulty?*

YesNo
If Yes, please provide further details
Do you have a Mental Health Issue?*

YesNo
If Yes, please provide further details?
Your ID checklist- Please tick the items of ID you have and upload them below.
Please upload photos of your selected ID here

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How did you hear about us?*
DWP Work Coach?*
What other organisations or programmes are you currently registered on/with?*
Do you have a Criminal Record?*

YesNo
If Yes, please give further details (all information is held as confidential and will be dealt with discreetly and professionally)
What was your last job? When and why did it end?*
What qualifications/courses have you done in the past?Maths? English? ICT?Please enter grades*
Do you have access to a computer and the internet at home?*

YesNo
How do you currently fill your spare time?*
What type of job are you looking to secure in the future?*
Do you have any particular requirements (eg hours of work, location/distance to travel)?*
What steps have you taken to gain employment?*
Do we have a copy of your current CV*

YesNoI don't have one
Please upload a copy of your CV here

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What country have you legally resided in for the last 3 years?*
Ethnic origin?*
Household Situation, do any of these apply to your situation?*

No household member is in employment and the household contains one or more childrenNo household member is in employment and the household doesn't contain one or more childrenYou live in a single adult household with childrenNone
Do any of these apply you within the last three months.*

Returner to labour marketEx offenderDrug/ alcohol misuseRefugeeHomelessLone ParentNone
I hereby confirm that this information is true and accurate*

I AgreeI Do Not Agree
Here at Go4it we take your privacy seriously and will only use your personal information to provide you with the training you have requested from us. In doing so, it may be necessary to share specific information with our Funding Partners and the Awarding Bodies. If you consent to us passing on your details for this purpose, please tick to confirm*

I Agree
From time to time, we may also like to contact you with details of other training opportunities. If you consent to us contacting you for this purpose, please tick to say how you would like us to contact you*

PhoneTextEmailPost
Date*

DayMonthYear
Date
Signature*

Clear
Wet Signature

Clear
Should be Empty:

If something has a red star next to it it is required, if you do not know the answer or it doesn't apply please supply your initials in this field.