Employability Support Referral Form
Version Date: June 2025
IMAGE: The form displays an employability-related organisational logo and the Orkney Islands Council crest at the top of the page. The text within the employability logo is not fully legible.
Referral Details
| Field | Details | Field | Details |
|---|---|---|---|
| Referring Agency | Date of Referral | ||
| Name of Referrer | Role | ||
| Email Address | Tel Number (Work) | ||
| Address (including Post Code) |
Participant Details
| Field | Details | Field | Details |
|---|---|---|---|
| Name | Date of Birth | ||
| Email Address | Tel Number | ||
| Address (including Post Code) |
Reasons for Referral
Please detail below any relevant information e.g. work already completed with referrer, goals for the future, relevant historical info, home and family life
IMAGE: The second page displays the same employability-related organisational logo and Orkney Islands Council crest at the top. The text within the employability logo is not fully legible.
Additional Information
Please detail below any relevant additional information e.g. emotional support needs, details of agencies involved with the participant, etc.
Health and Safety
Please detail any further information you feel we should know with regards to health and safety
Contact Preferences
| Contactable by email | Contactable by phone | Contactable by Text |
|---|---|---|
| ☐ | ☐ | ☐ |
The information given on this form will be used to provide you with the support you require to develop and work towards your Individual Development Plan. The information may also be passed to other relevant organisations for the purpose of delivering, monitoring and evaluating funding and to provide you with support and advice whilst monitoring your personal progress.
The reasons in which we retain and share your personal information are legally justified under the General Data Protection Regulation. This referral will be stored securely and only staff who need to know will access the information. For further information on this, please refer to Privacy Information Notice (orkney.gov.uk).
Participant: I consent to this referral being made to the Orkney Islands Council Employability Team and give explicit consent to my personal information being stored by OIC and shared appropriately between the organisations supporting me. I also agree to my information being shared with Scottish Government for reporting purposes.
Signature:.......................................................................................... Date: .................
Signature of Representative from Referring Agency:....................................... Date: ...............
Version Date: June 2025