Barts Community Works for Health - Registration Form
Where did you hear about the programme?
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NEWSPAPER ADVERT
Waltham Forest Council Newsletter
RECOMMENDATION
JOB CENTRE
WEBSITE
Waltham Forest Council Website
REFERRED BY ORGANISATION/INDIVIDUAL
OTHER (please specify)
Other website
Project Zero
Facebook
Instagram
LinkedIn
Snapchat
YouTube
WhatsApp
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Participant Details
Title
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Mr
Miss
Ms
Mrs
Other
Forename
Surname
Mobile Phone No.
Email Address
Are you a resident of Waltham Forest
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Yes
No
Address
Postcode
Date of Birth
Gender
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Male
Female
Ethnicity
Please select...
Asian/Asian British - Bangladeshi
Asian/Asian British – Indian
Asian/Asian British – Pakistani
Asian/Asian British - Chinese
Asian/Asian British - Other (please specify below)
Black/Black British - African
Black/Black British - Caribbean
Black/Black British - Other (please specify below)
Mixed/Mixed British - White and Asian
Mixed/Mixed British - White and Black African
Mixed/Mixed British - White and Black Caribbean
Mixed/Mixed British - Other (please specify below)
White British - English/Welsh/Scottish/Northern Irish
White Irish
White Gypsy or Irish Traveller
White Other (please specify below)
Other Ethnic Group (please specify below)
Other Ethnicity
Current Situation
Employed?
Please select...
No
Yes
If unemployed, please state how long:
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0-6 months
6 - 12 months
12-24 months
2-3 years
3 years or more
Are you currently studying
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Yes
No
Part Time
Evenings
Weekends
Do you consider yourself to have a disability, health condition or mental health need that we should be aware of, in order to support your needs?
(This information helps us ensure accessibility and provide any necessary support. It will be treated confidentially.)
Yes
No
If “Yes,” please provide details:
Do you have any past convictions spent and non-spent or anything that could appear on a DBS?
Yes
No
Essential Criteria
Possess a level 2 Maths & English qualification (must provide evidence)
Yes
No
Able to produce 2
referees
essential for employment/placement
Yes
No
Have worked or completed a work placement recently
Yes
No
Commit to a one-week training course (9.30am to 4pm)
Yes
No
Committed to applying for NHS roles post-course completion
Yes
No
A CV is required to apply for this program.
Upload your CV
By ticking this box you give consent for your personal information to be processed (based solely on the applicable data protection regulations) by the London Borough of Waltham Forest Employment service for the purpose of finding you a job or training opportunity.
You are also agreeing to be contacted by London Borough of Waltham Forest Employment service regarding other opportunities that we feel may be of interest to you. Your details will be held on our secure database in line with DP and GDPR legislation for the purposes as outlined above. We will treat all of your data as strictly confidential, in accordance with statutory provisions and will not share with any parties outside of the organisation.
To learn more about how your personal data will be used please click the ‘Your Rights Under GDPR’ link at the bottom of this page.
You can withdraw your consent at any time by contacting the service via email at:
stepsintowork@walthamforest.gov.uk
stating your full name and email address.
Contact Information
Your Rights Under GDPR