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First Name(required)

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Last Name(required)

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Email(required)

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Phone(required)

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Gender(required)

Male

Female

Prefer not to say

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Ethnicity(required)

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Do you have a faith?(required)

Yes

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Section 2: Your aims (please tick all that apply)

Therapeutic activities Help with improving personal coping skills in the workplace Voluntary work in the community Career/job advice and guidance Further education and learning Gaining/sustaining employment

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Please describe how you spend your time now? For example volunteering, education etc.(required)

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If you are unemployed, how long have you been unemployed?(required)

Less than 6 months

6 to 12 months

Over 12 months

I am employed

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Do you have qualifications(required)

Yes

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If yes, what is the highest qualification you have achieved?

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Use the space below to tell us about your career aspiration(s), if funded. How will funding have a positive impact?(required)

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Reference Contact Details (Support Worker, pastor etc)(required)

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Training Required By Date (YYYY-MM-DD)(required)

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Opening Doors to Hope, Empowering Lives Beyond Addiction

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