WorkWell Fenland contact form

Eligible
1. WorkWell Fenland is a free service for people who are struggling to find or retain a job due to physical or mental health.
  
  You are eligible for WorkWell Fenland if:
  
  • You are aged 16 or over, and
  
  • You have the right to work in the UK, and
  
  • You live in Fenland or are registered with a GP or JobCentre Plus in Fenland, and
  
  • You have a health-related issue that is making it difficult to get work or stay in a job (whether you are struggling with physical or mental wellbeing)
  
  Please complete this form if you are interested in finding out more about WorkWell Fenland and one of the team will be in touch.
Applicant Details
1. First name*
2. Last name*
3. Date of birth:*
4. Please tick the below box to confirm you are aged 16 or over*
5. Email address
6. Telephone number*
7. Do you live in Fenland?*
  
  Yes
  
  No
8. Are you registered with a GP or JobCentre Plus in Fenland?*
  
  Yes
  
  No
9. If you feel able to, please share brief details of the difficulties you are facing, but don’t worry our coaches will discuss this with you:
10. If you are completing this form on behalf of someone else, please confirm they have given their consent for us to contact them by ticking this box
11. Where did you hear about WorkWell?*
  
  JobCentre Plus
  
  Social Media
  
  Magazine / Newspaper
  
  Employer
  
  Leaflet in with council tax or non-domestic (business rates) property bill
  
  Other (please describe in the box below)
12. If you answered 'Other' in the question above, please tell us where you heard about WorkWell:
Data Protection
1. Fenland District Council will use the information you give on this form to process your request for service. In certain cases, your data will be shared with our trusted partners (third parties) to fulfil your request. Your information will be stored securely in accordance with our privacy and data retention policies. Please visit www.fenland.gov.uk/privacy for more information.

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WorkWell Fenland contact form