Registration Form
Date
*
-
Day
-
Month
Year
Date Picker Icon
Staff Name
*
Please Select
Delrose Earle
Ayisha Salman
Talita Moffatt
Sarah Day
Registered at
*
Mitcham Job Club
Donald Hope Job Club
Bus Job club
Office
Personal details
Job Club Location
Please Select
Miss
Mrs
Mr
Client Title
*
Please Select
Miss
Mrs
Mr
First Name
*
Family Name
*
Address
*
Town:
*
County
Postcode:
*
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Which District do you live in?
Please Select
Bushey Mead
Colliers Wood
Copse Hill
Cottenham Park
Lower Morden
Merton Park
Mitcham
Morden
Morden Park
Motspur Park
Phipps Bridge
Pollards Hill
Raynes Park
St helier
South Wimbledon
Summerstown
West Barnes
Wimbledon
Wimbledon Park
Which Ward do you live in?
Please Select
Abbey
Cannon Hill
Colliers Wood
Cricket Green
Dundonald
Figges Marsh
Graveney
Hillside
Lavender Fields
Longthornton
Lower Morden
Merton Park
Pollards Hill
Ravensbury
Raynes Park
St Helier
Trinity
Village
West Barnes
Wimbledon
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Telephone:
*
Email:
*
Confirmation Email
Date of Birth:
*
-
Day
-
Month
Year
Date Picker Icon
National Insurance Number::
Are you a UK/EU Citizen?
*
Please Select
YES
NO
What is your nationality
*
Do you live within the Merton Borough
*
Please Select
YES
NO
Are you a Circle Housing Merton Priory (CHMP) tenant
*
Please Select
YES
NO
Housing status
*
Circle Housing (CHMP) Freeholder/Leaseholder
Owner Occupier
Privately Rented
Other Housing Association Tenant
Other
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Employment status
*
Unemployed for more than 6 months
Unemployed for less than 6 months
Employed more than 16 hours per week
Employed less than 16 hours per week
In full time education or training
NEET
Retired
Other
Benefit Status
*
Jobseeker's Allowance (JSA)
Employment and Support Allowance (ESA)
Income Support (IS)
Disability Living Allowance (DLA)
Housing Benefit
Child Tax Credit/Child Benefit
Working Tax Credit
Universal credit
Other
Priority groups - Are you a member of one of these groups?
*
Lone Parent/Carer
Person with physical disability
Ex-offender
Person with learning difficulties
Person with mental health issues
Care leavers/looked after children
None of the above
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How did you hear about us?
*
Leaflet/Card
Job Centre Referral
Friend/Neighbour
Newspaper Advert
Training Provider
Circle Website
Circle Letter/Email
Circle Staff
Other
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Please complete the next section
Gender
*
Female
Male
Transgender
Prefer not to say
Age
*
16-20
21-25
26-30
31-40
41-50
51-64
65+
Prefer not to say
Ethnic Background
*
White British
Black Other
White Other
Black British
Asian Other
Asian British
Mixed Other
Mixed British
Faith/Religious Background
*
Christian
Muslim
Jewish
Hindu
Sikh
Buddhist
None
Other
Do you have a disability or long term health issue?
*
Yes
No
Prefer not to say
Sexual orientation
*
Heterosexual
Lesbian/gay
Bisexual
Transsexual
Prefer not to say
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Section not to be completed
Self Employed
Accessed non accredited training
Gained a Qualification
Had IAG
Number of IAG sessions
Training Completed
Work Experience
Aprenticeship
Employment Gained
Date of Employment
3 Month Check
Total Days Employed
Remarks
Please proceed to the final section
What is the main reason for doing this project?
*
To learn new skills
Gain a qualification
Improve career or job prospects
For personal interest/leisure
To make new friends
Other
Current knowledge/skill level 1-5 (low to high)
*
Can we use images of you for publicity
*
Please Select
Yes
No
Can we take pictures for monitoring?
*
Please Select
Yes
No
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I am interested in
*
Employability Support
Start Your Own Business
Job Club / Support with Job Search
Construction
Customer Service
Sports and Leisure
Health and Social Care (Adult)
Security
CV Writing and Interview Skills
ESOL
Entry Level Maths
Entry Level English
IT Basics
What are your next steps
Have you run a business before?
*
Yes
No
If yes, how long?
*
What type of business do you want to open now?
*
What are the three main things you want to get from this course?
1.
*
2.
*
3.
*
We will contact you with course dates and information
Please tell us which type of work you are interested in:
*
Skills
Do you have a current full driving licence?
Yes
No
Do you have any points?
Yes
No
If yes, how many?
On a scale of 1-5 (1 being poor, 5 being excellent) please rate your current skill levels
1
2
3
4
5
Computing
Numeracy
Literacy
Confidence
Customer Service
Communication
Teamwork
Time Management
Flexibility
Planning
Organisation
Creativity
Leadership
Negotiation
Attitudes to Work
Additional Information
Your CV and Cover Letter (optional)
Attach your CV
Attach your Cover Letter
Declaration and Signature
Print name:
*
Date
*
-
Day
-
Month
Year
Date
I certify that the information contained in this application is true and complete. I understand that false information may be grounds for termination of employment or training. I authorise the verification of any or all information listed above. In accordance with the terms of the Data Protection Act 1998. I hereby agree that my name and personal data may be shared by Circle, with its Group Members and partners. I also agree that a myworksearch account is created with the information contained in my application.
*
Agree
Submit
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