REGISTRATION FORM - Family Mosaic

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SECTION 3 Are you:- Employed Yes No If unemployed please indicate period of unemployment Under 6 month 6 - 12 months 12 – 18 months ‎18‎ٱ months+ Are you currently in receipt of benefits (e.g. Job Seekers Allowance, Employment Support Allowance, Income Support, Incapacity Benefit or Disability Living Allowance)? _____________________________________________________________ Do you feel confident with the following in everyday situations? Reading: Yes No Writing: Yes No Maths: Yes No Yes No Yes No Yes No SECTION 4 Do you know how to use a computer? Yes No Are Would you you a lone like parent? training? Yes No Yes No Are you a refugee? Yes No Are you an asylum seeker? Yes No Are you homeless? Yes No Have you ever had a problem with drugs/alcohol? Yes No Have you had contact with the probation service in the last 2 years? Yes No If yes please give details: _________________________________ ______ ____________________________________________________________________ ____________________________________________________________________ SECTION 5 Do you have a disability (mental or physical)? Yes No Do you have any support needs? Yes No If yes please state: _________________________________________________________ 2
SECTION 6 Please tick all areas of work you are interested in. Administration Reception Customer Service Care Worker Childcare Bar Work Construction Data Entry Driving Gardening Hotel Computing & IT Restaurant Retail Languages Security Warehouse Sales Self-Employed Other………………………………………………………..……. If you have expressed an interest in Administration Work, what is your typing speed (if known) WPM?: _______________________ Are you looking for full time work, or would you consider either:- (Please tick) Self-employed Part-time Full-time Either If you are looking for specific hours of work please give more information here ___________________________________________________________________ SECTION 7 If you are training/studying, please complete the following section: Start Date of Course: ____/____/_____ End Date of Course:____/_____/_____ Subject/Course Title:__________________________________________________________ Level: ________________________ Qualification:__________________________________ Do you have a NVQ level qualification? If so what level is it? 0 1 2 3 4 5 Equivalent to: CSE 5 GCSEs 2 A Levels 1 st Degree Higher Degree (A-C) Please state any other qualifications you have __________________________________ __________________________________________________________________________ 3
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REGISTRATION FORM - Family Mosaic

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