Northern Ireland European Social Fund Programme

1. Personal Details
Name:
Address:
Postcode:
Telephone Number:
Mobile No:
Date of Birth:

Male:

Female:

2. Which of the following groups do you consider you belong to?
White:		Black African:		Bangladeshi:
Chinese:		Black Caribbean:		Pakistani:
Indian:		Black Other:		Irish Traveller:
Mixed Ethnic Group:		Other Ethnic Group:

3. Do you belong to any of the following groups:

Lone Parent:
Migrant:
Other Disadvantaged:

4. Do you have a disability?

Yes:
No:

5. National Insurance Number: Participation in the W2B Programme does not affect your benefits etc in any way

6.  Employment / Unemployment
Are you:

Under Employed (less the 16 hours):
Unemployed:
Inactive but in education or training:
Inactive but not in education or training:

7. If you have been out of work, please answer the following. How long have you been out of work?

Less than 6 months:
6 - 11 months:
12 - 23 months:
24 + months:

8. Are you a new entrant to the labour market?
(e.g.) never worked or looked for full time work before, such as school leaver

Yes:
No:

9. Are you a returner to the labour market?
(You have worked in the past but were absent from the labour market for a period of time for any reason)

Yes:
No:

10. Qualifications - What is the highest qualification (or equivalent) that you hold?

Below NVQ Level 1
NVQ Level 1 (GCSE/SCE/O Level)
NVQ Level 2 (5+ GCSE/SCE/ O Level)
NVQ Level 3 (2+ A Levels/4+ AS Levels
NVQ Level 4 (Degree, Teaching Qualification
No Qualifications (Higher Degree)
Other - please detail

11. Have you been on any other ESF funded programmes in the last 3 years?

Yes:

No:

12. Please select one:

I want to move into self- employment (start my own business):
I want to move into employment (a new career):

 

Completion of the following sections is Voluntary  

1. Marital Status
Single (Never Married):		Married and living with husband:
In a civil partnership:		Married and separated:
Divorced:		Widowed:

 

2. Dependants
A child or children:		A person with a disability:
A dependent elderly person:		None of the above:

3. Community Background
I am a member of the Protestant community:
I am a member of the Roman Catholic community:
I am a member of neither the Protestant or Roman Catholic community:

The Department for Employment and Learning is committed to equality of opportunity and fair treatment in all of its programmes and services.  This places an obligation on the Department to monitor, as accurately as possible, the religious and ethnic backgrounds, age, marital status, gender, disability and dependants responsibility of participants in order to ensure that programmes and services are delivered on the basis of equality of opportunity and fair treatment, and if not to take corrective action.  You have already been asked to provide information on your ethic background, age and gender in the Personal Details section of this registration.

 

Access to this information will be strictly controlled and will only be used for equal opportunity monitoring purposes.  It will not be given to any person, employer or organisation outside the Department for Employment and Learning or this project. 



 

 

I declare that the details given on this form are true to the best of my knowledge