Islington Supported Employment (ISET) Team Referral Form

Support for Islington residents over 18 years old, with a Global Learning Disability (GLD) and/or Autism to access support finding and sustaining paid employment.We also support young people 18-25 who are neurodivergent , who have special educational needs or disability but not a global learning delay

Out of work residents - who are seeking paid employment: ISET can provide a tailored support for 12 months, in line with the Supported Employment Quality Framework (SEQF). An ISET employment specialist will contact the resident within 7 working days from the referral date and support to an individual will start within 10 days of their date of referral.

In-work residents - who are working but would like support to manage a difficult situation at work or would like to explore other paid roles: ISET employment specialist can provide a tailored support within 5 working days of receiving the referral, for a period of 6 months

1: Name of the person making the referral 
Name of the person making the referral must be provided  Select only one Name of the person making the referral 
Name of the person making the referral
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2: Date of the referral 
Date of the referral must be provided  Select only one Date of the referral 
Date of the referral
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3: Referrers email address 
Referrers email address must be provided  Select only one Referrers email address 
Referrers email address
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4: Referrers telephone number 
Referrers telephone number must be provided  Select only one Referrers telephone number 
Referrers telephone number
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5: Referrers organisation 
Referrers organisation must be provided  Select only one Referrers organisation 
Referrers organisation
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6: Forename 
Forename must be provided
7: Surname 
Surname must be provided
8: Date of birth 
Date of birth must be provided
You must be at least 16 years old to register
Date of birth *
For example, 31 3 1980
9: Address Line 1 
Address Line 1 must be provided
Select Address  Clear Address
13: Postcode 
Postcode must be provided
15: Email address 
Email address must be provided
16: Does the person has the right to work in the UK? 
Does the person has the right to work in the UK? must be provided  Select only one Does the person has the right to work in the UK? 
Does the person has the right to work in the UK?
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17: National Insurance Number 
National Insurance Number must be provided
18: Is the person in paid employment? 
Is the person in paid employment? must be provided  Select only one Is the person in paid employment? 
Is the person in paid employment?
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19: Next of Kin Name 
Next of Kin Name must be provided  Select only one Next of Kin Name 
Next of Kin Name
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20: Next of Kin contact details 
Next of Kin contact details must be provided  Select only one Next of Kin contact details 
Next of Kin contact details
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21: Country of origin 
Country of origin must be provided  Select only one Country of origin 
Country of origin
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22: Ethnic Origin 
Ethnic Origin must be provided
23: Gender 
Gender must be provided
24: Religion 
Religion must be provided  Select only one Religion 
Religion
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25: Does the person have a disability? 
Does the person have a disability? must be provided  Select only one Does the person have a disability? 
Does the person have a disability?
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26: Please give details of the person''s disability 
Please give details of the person''s disability must be provided  Select only one Please give details of the person''s disability 
Please give details of the person''s disability
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27: Does the person consider themselves to be neurodivergent? 
Does the person consider themselves to be neurodivergent? must be provided  Select only one Does the person consider themselves to be neurodivergent? 
Does the person consider themselves to be neurodivergent?
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28: Do you have an education health and care plan (EHCP)? 
Do you have an education health and care plan (EHCP)? must be provided  Select only one Do you have an education health and care plan (EHCP)? 
Do you have an education health and care plan (EHCP)?
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29: Please provide details of your SEND needs/additional needs with employment below? 
  Select only one Please provide details of your SEND needs/additional needs with employment below? 
Please provide details of your SEND needs/additional needs with employment below?
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30: Benefit information 
  Select only one Benefit information 
Benefit information
31: Highest Skills and Qualifications 
  Select only one Highest Skills and Qualifications 
Highest Skills and Qualifications
32: Is the person a parent? 
Is the person a parent? must be provided  Select only one Is the person a parent? 
Is the person a parent?
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33: Please state which industry sector would the person like to work? 
Please state which industry sector would the person like to work? must be provided  Select only one Please state which industry sector would the person like to work? 
Please state which industry sector would the person like to work?
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34: Please state any known risks or trigger when working with the person? 
Please state any known risks or trigger when working with the person? must be provided  Select only one Please state any known risks or trigger when working with the person? 
Please state any known risks or trigger when working with the person?
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35: Does any of the following describe the person? 
Does any of the following describe the person? must be provided  Select only one Does any of the following describe the person? 
Does any of the following describe the person?
36: Is the client known to Islington Learning Disability Partnership (ILDP) 
Is the client known to Islington Learning Disability Partnership (ILDP) must be provided  Select only one Is the client known to Islington Learning Disability Partnership (ILDP) 
Is the client known to Islington Learning Disability Partnership (ILDP)
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37: Travel needs - does the client requires travel training? 
Travel needs - does the client requires travel training? must be provided  Select only one Travel needs - does the client requires travel training? 
Travel needs - does the client requires travel training?
38: Communication needs 
Communication needs must be provided  Select only one Communication needs 
Communication needs
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39: How best to contact the client 
How best to contact the client must be provided  Select only one How best to contact the client 
How best to contact the client
40: Any other information? 
  Select only one Any other information? 
Any other information?
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41: Mobility needs 
  Select only one Mobility needs 
Mobility needs
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* Data Protection Notes


Data Privacy and Information Sharing

We will handle the information you have provided in line with the provisions of the Data Protection Act 2018. Any personal information will be held in confidence with only the necessary people able to see or use it. For more information about how we use your information, please see our privacy notice here:

[iWork Privacy Notice Link or https://www.islington.gov.uk/about-the-council/information-governance/data-protection/privacy-notice

Please note that as part of the service we offer, we will share your details with prospective employers or other agencies. The employers or agencies will in return share basic information about you with us so that:

1) We are not double-counting (change or add as necessary) when we report on residents supported into work . or residents sustaining in work
2) We are able to check on our referrals and feedback to partners regarding client satisfaction
3) We meet our duties in relation to equalities monitoring and corporate / ASCOF reporting ( deleting, change or add as necessary)

If you obtain employment through this programme, we will need to contact your employer for confirmation that you have secured, and remained in, employment. For funding purposes, we may be required to share your data with the funding organisation, for example DWP. This will be done securely and only your name, NI Number, date of birth and post-code would be shared. In addition, your CV may be forwarded to employers using non secure email.

Please sign and date below to confirm that: you have read the statement above; you have had the reasons for information sharing explained to you and you understand those reasons; and that the information you have entered in the form above is correct:
Do you agree to the data protection terms and conditions?
Client:
Date: ......................... Signed: .......................................
Caseload:
Date: ......................... Signed: .......................................