Would you like to refer yourself to Working Well Norfolk?

Fill in the form below to refer yourself to Working Well Norfolk.

Please fill in the form below ensuring that all the “Required” boxes are complete. This information is needed for us to assess your eligibility for the programme.

Section 1 - Eligibility and background

Can you confirm that you are a resident of Norfolk and are not on any other employment programme or receiving employment support except from Job Centre Plus?(Required)
Which of the following best describes your current circumstances? (Select One option)(Required)
Are you 16yrs or over?(Required)
Which of the three eligible groups applies to your current circumstances?(Required)

Section 2 - Your details

Name(Required)
DD slash MM slash YYYY
Email(Required)
Address(Required)
Do you have a birth certificate or passport?(Required)

Your Personal Data

Seetec is committed to data security and the lawful , fair, and transparent processing of personal data. We will process the personal information you provide only for the purposes of joining the Working Well Norfolk Programme.

Your data will be retained only for as long as necessary to complete this process, and if you decide that you no longer wish to join the programme or your referral is not approved, your data will be deleted from our systems within 30 days of notification.

We may retain anonymised data (data which cannot be associated with you) for statistical and reporting purposes.

For further information on how Seetec processes personal data, please see our privacy policy.

Have a question? Call us 0800 334 5525 Contact us