Apply for Ongo Talk Ongo Talk application form Your details Name * Gender Male Female Prefer not to say Date of Birth Address Postcode Phone number Mobile number Email address Ethnicity: Please pick just one category that you feel best describes your ethnic origin. Asian/ Asian British Indian Pakistani Bangladeshi Chinese Other Black/Black British Caribbean African Other Dual heritage White and Black Caribbean White and Black African White Asian Other Other ethnic group Arab Other White British English Northern Irish Scottish Welsh Irish Gypsy, Irish Traveller or Roma Other Your eligibility Which item of evidence can you provide? We need to check that you have the right to live and work in the UK. This means we need you to provide one item of evidence from the list below. We must see an original and we will make a photocopy for our own records. Tick one box to confirm the item of evidence you’re providing: A National Insurance number, either in the form of the plastic card or a letter from HMRC. Passport showing that you are a British citizen or a national from a European Economic country. A full birth or adoption certificate, issued in the United Kingdom, Channel Islands, the Isle of Man or Ireland. A full passport, residency permit or visa stamp granting indefinite leave to remain or no time limit on your stay. A letter from the UK Immigration and Nationality Directorate or the Home Office granting indefinite leave to remain or no time limit on your stay. An Identity Card issued by the Home Office granting indefinite leave to remain or no time limit on your stay. Your employment status Tick one box below to confirm the evidence you are providing We need to check if you are: out of work and unemployed, which means you are currently looking for work and may be receiving unemployment benefits of some kind or out of work and economically inactive, which means you are not currently looking for work for some reason. We must see an original and we will make a photocopy for our own records. If you’re registered unemployed, a letter or document from Jobcentre Plus or the Department for Work and Pensions confirming this. If you’re unemployed but not registered, a letter or document from a government agency, such as the Careers Service, confirming this. If you’re economically inactive, where possible a letter a document to support this, such as a doctors letter, state pension book or correspondence from an educational establishment. If you are unemployed, in months, how long have you been out of work? Are you currently in education or training? Yes No If you answered yes to the above question, tell us more about it. Include details of the course, institution or provider. Are you currently claiming any benefits? Yes No If you are claiming benefits, which ones are you claiming for? IB/ESA or any other sickness related benefit Jobseeker's allowance Disability Living Allowance Income Support Other If you selected 'other' from the list above, please state which other benefit you are claiming for: Are you in paid work of any kind? Yes No Household situation Are you currently homeless? Yes No Prefer not to say Not including yourself, do you currently live or stay with one adult? Yes No Prefer not to say Including yourself, is everyone you live or stay with out of work? Yes No Prefer not to say Do you live with children you have responsibility for? Yes No Prefer not to say Do you have sole caring responsibility for a child? Yes No Prefer not to say Other information Are you an ex offender? Yes No Prefer not to say Do you consider yourself to have a disability? This is a physical or mental impairment that has a substantial and long-term negative effect on your ability to do normal daily activities. Yes No Prefer not to say Do you consider yourself to have a work limiting health condition? This is a health condition that has an impact on your ability to work or remain in work. Yes No Prefer not to say What is your sexual orientation? Heterosexual Bisexual Gay/ Lesbian Prefer not to say Participant declaration Tick each box to confirm: The support I will be offered is funded by the European Social Fund. The information provided in the form is, to the best of my knowledge, accurate. If I have ticked a ‘Prefer not to say’ option anywhere on this form, I confirm that I am refusing consent for this information to be collected. I give permission for my personal details to be shared with CLLD and other authorised bodies I understand that this information will be retained until at least 31 December 2028 for evaluation purposes. I may be contacted at any time to discuss my involvement in the project. I confirm I understand I will be required to complete a HACT questionnaire about my personal situation now and again in the next three months to support the project outcomes. Data protection Any personal information you provide to us on this form will be treated in accordance with current UK data protection law and our data protection policies, procedures and privacy notices in place from time to time. For full details of how we will use your personal information and comply with current UK data protection law please see our privacy notice. A copy of our privacy notice is available at www.ongo.co.uk or on request. Please check your answers above Ongo comply with General Data Protection Regulation (EU) 2016/679 (‘the GDPR’) and the Data Protection Act 2018 (‘the DPA’). Take a look at our privacy statement here.