NJF Monitoring Form

							    NJF Monitoring Form
    Eligibility: Any out of work benefit
    18 – 24 years olds, 1-52 weeks unemployed and live within Nottingham City boundary.
    Disabled must meet above criteria, Guaranteed interview if meet Job/Person specification.
    Young Persons Day 1 eligibility if leaving the care of Nottingham City Council or been in care in the past 2 years.
    There are no claim restrictions
    Ex-offender – Day 1 eligibility for anyone with a criminal record




    Name                                Date of         NI Number              Benefit           Claim Start
                                        Birth                                                    date



    House No.        Address                                                   Post Code



Nottingham City Council is committed to providing services which embrace diversity and which promote equality of
opportunity. The information below will be used to evaluate the scheme. If you do not provide this information, entitlement
to Nottingham Jobs Fund and jobs offered will not be affected.

Please tick relevant boxes

    Ethnicity                                                   Faith
    White                                                       Baha'i Faith
    White British                                               Buddhism
    White Irish                                                 Christianity
    White Other                                                 Hinduism
    Duel Heritage                                               Islam
    Dual Heritage Caribbean / White                             Judaism
    Dual Heritage African / White                               Rastafarianism
    Dual Heritage White / Asian                                 Sikhism
    Other Dual Heritage                                         Zoroastrianism
    Chinese                                                     Other Religion
    Chinese                                                     None
    Asian                                                       Sexual Orientation
    Indian                                                      Heterosexual/Straight
    Pakistani                                                   Gay man
    Other Asian                                                 Gay Woman/Lesbian
    Black                                                       Bisexual
    Caribbean                                                   Other
    African                                                     Prefer not to say
    Other Black
    Other ethnic group                                          Are you currently in or have you been in
                                                                                                             Y      N
                                                                the care of NCC in the last 2 years?
                                                                Do you consider yourself disabled?
                                                                                                             Y      N
                                                                Do you have a criminal record?               Y      N
Nottingham Jobs Fund – consent to share information
Nottingham City Council has launched the Nottingham Jobs Fund which involves employers
and Jobcentre Plus working together to help our young people find employment.

To help us assess and improve the effectiveness of the Nottingham Jobs Fund, we need your
consent to hold, use and share personal information about you between the employer and
Jobcentre Plus.

The information the employer will share with Jobcentre Plus is:

Your name; date of birth; national insurance number; postcode, ethnicity and gender

The information will be provided by the employer to Jobcentre Plus and will be used to
evaluate the success of the scheme. To measure whether the schemes are successful or not,
we may match what your employer tells us to details already held by the Department for Work
and Pensions. The information may also be used by our evaluation team; it will not be passed
to any other organisation who is not directly involved in evaluating the success of the scheme.

If you do not give consent, entitlement to any Nottingham Jobs Fund jobs offered will not be
affected. You can write to us at any time to withdraw your consent and your job will not be
affected.

Consent for employers and / or Nottingham Jobs Fund Lead Accountable Bodies to
share information with Jobcentre Plus

Name …………………………………………. (Please print name in full)

National Insurance No:



I authorise Nottinghamshire Wildlife Trust and Jobcentre Plus to share information
about any of the Nottingham Jobs Fund jobs I have applied for.

I have read the information above and understand:
    Why Nottinghamshire Wildlife Trust and Jobcentre Plus need to share information about
      my employment, and how the information will be used.
    That if I am in receipt of any benefits, my entitlement to these benefits will not depend on
      whether I choose to give consent or not.
    That I can withdraw consent at any time by writing to Jobcentre Plus


Signature:.…………………………………….Date