Our Newham Initial Contact Form
Fill in the form below
1:
Are you a Newham Resident / or placed out of borough by Newham Council?
Are you a Newham Resident / or placed out of borough by Newham Council? must be provided
Select only one Are you a Newham Resident / or placed out of borough by Newham Council?
Are you a Newham Resident / or placed out of borough by Newham Council?
Yes, I am a resident of Newham
No, I am not a resident of Newham
2:
Do you have the right to work in the UK?
Do you have the right to work in the UK? must be provided
Select only one Do you have the right to work in the UK?
Do you have the right to work in the UK?
Yes
No
3:
National Insurance Number
National Insurance Number must be provided
4:
Title
Select only one Title
Title
Miss
Mr
Mrs
Ms
Sir
5:
Forename
Forename must be provided
6:
Surname
Surname must be provided
7:
Gender
Gender must be provided
Female
Male
Transgender
Non-binary
Prefer not to say
8:
Date of Birth
Date of Birth must be provided
You must be at least 16 years old to register
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Invalid date - please enter a valid date in the format dd/MM/yyyy for input Date of Birth
9:
Ethnicity
Ethnicity must be provided
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Indian
Asian or Asian British - Other
Asian or Asian British - Pakistani
Black or Black British - African
Black or Black British - Caribbean
Black or Black British - Other
Mixed - Other
Mixed – White and Asian
Mixed – White and Black African
Mixed – White and Black Caribbean
Other Ethnic Group - Arab
Other Ethnic Group - Other
White - British
White - English
White - Gypsy or Irish Traveller
White - Irish
White - Northern Irish
White - Other
White - Scottish
White - Welsh
Not known
Prefer not to say
10:
Address line 1
Address line 1 must be provided
Select address
Clear address
11:
Address line 2
12:
Address line 3
13:
Address line 4
14:
Postcode
Postcode must be provided
Enter a full UK postcode
15:
Mobile Number
Mobile Number must be provided
16:
Email address
17:
How do you prefer to be contacted (select all that apply)
How do you prefer to be contacted (select all that apply) must be provided
Contactable by email
Contactable by phone
Contactable by sms
18:
Do you have recourse to public funds?
Do you have recourse to public funds?
If selected press tab to add details
Do you have Recourse to Public Funds?
Yes
No
19:
Is this a referral?
Is this a referral? must be provided
Is this a referral?
If selected press tab to add details
Is this a referral?
Yes
No
20:
If yes, Referrer details
If yes, Referrer details
If selected press tab to add details
Referrer Name
Referrer Name
If selected press tab to add details
Organisation/Service
If selected press tab to add details
Contact Number
If selected press tab to add details
Email
21:
Where did you hear about us?
Where did you hear about us?
Marketing group
Referral Source
Marketing
-1
Further details
* Data Protection Notes
Our Newham Work is funded by the London Borough of Newham and works with local residents to support them in finding and sustaining employment suited to their needs. This form represents a contract between you and Our Newham Work, the London Borough of Newham’s job brokerage. By signing this form you agree to provide personal data so that Our Newham Work can provide services and benefits to you as described on this form.
What Our Newham Work will do with your personal data
This may include:
• Your Personal Advisor will use your personal data to:
o Keep in contact with you
o Provide job search, CV support, interview preparation and other support
o Inform you of vacancies via email or telephone call available through Our Newham Work
o Inform you of suitable training and other support which may be available
• Our Newham Work may pass your personal data to a training provider where you have been placed on a training course through Our Newham Work
• Our Newham Work may pass your personal data to an Employer where you have been
put forward for a vacancy through Our Newham Work
• Our Newham Work may, in discussion with you, refer you to third party organisations where we feel you may benefit from their services and we may pass your details to them when we do this
• Our Newham Work will include your data to produce, reports, statistics and external funding submissions relating to Our Newham Work activities
• Our Newham Work may occasionally (maximum of once per year) pass your personal data to a third party organisation commissioned to evaluate the Our Newham Work service. This organisation may then contact you to seek your opinion of the quality and value of the service. The evaluation report will be in either an anonymised report or a report containing some identifying characteristics.
• Our Newham Work will keep your data for ten years to comply with contractual obligations with our external funders.
Provision of Employment Evidence
As a participant in the Our Newham Work Programme you will be required to provide evidence when you find employment and may be asked to provide evidence of continued employment at 13, 26 and 52 weeks. This may be in the form of a payslip or written evidence from your employer.
Alternatively, if you are unable to provide the evidence, you are agreeing for Our Newham Work to contact your employer to obtain the evidence which may include providing them with personal information such as Name, NI number and/or Date of Birth.
Declaration
All the information I have provided or shall provide is or will be accurate to the best of my knowledge.I understand that information about me may be kept and used as described above in order to deliver the service Our Newham Work provides to me.
Do you agree to the data protection terms and conditions?
Accept
Decline
Client:
Date:
.........................
Signed:
.......................................
Caseload:
Date:
.........................
Signed:
.......................................
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