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Working for Families: Lessons from the Pilot Projects (Stage 1)
Appendix Two Profile, Baseline and Soft Indicator Monitoring Information
Working for Families Funding
Monitoring and Evaluation Pro-forma
To be completed when the client first enters the programme.
Profile Information
1. Name: _______________________________________________________
2. Address: _____________________________________________________
Postcode: ______________________________________________________
3. Gender:
4. Age:
15-19 | 1 |
20-24 | 2 |
25-29 | 3 |
30-34 | 4 |
35-39 | 5 |
40-44 | 6 |
45-49 | 7 |
50+ | 8 |
5. Main language:
English | 1 |
Other (please specify) | 2 |
6. Residency status:
EU Citizen | 1 |
UK Visa Holder | 2 |
Asylum seeker | 3 |
Refugee (Indefinite Leave to Remain (ILR)) | 4 |
Refugee (Humanitarian Protection (HP)) | 5 |
Refugee (Discretionary Leave (DL)) | 6 |
7. Status:
Single | 1 |
Living with partner/husband | 2 |
Widowed | 3 |
Divorced/separated | 4 |
8. Do you suffer from any disability?
9. If YES is this (please tick all that are applicable):
Physical | 1 |
Medical | 2 |
Mental | 3 |
Other (please specify) | 4 |
10. How many dependent children do you have?
(please indicate numbers in appropriate boxes)
Gender | Age |
| 0-3 | 4-5 | 6-10 | 11-15 |
Male | | | | |
Female | | | | |
11. Do any of your children have disabilities?
12. Are you caring for any other non-child dependents?
13. If YES please give details.
______________________________________________________________
______________________________________________________________
______________________________________________________________
14. Qualifications held: (please tick all that are appropriate):
No qualifications | 1 |
Access/Foundation Standard Grade | 2 |
General Standard Grade/Intermediate 1 (equivalent to SVQ level 1) | 3 |
Credit Standard Grade/Intermediate 2 (equivalent to SVQ level 2) | 4 |
Higher (equivalent to SVQ level 3) | 5 |
A Levels and SYS or Advanced Highers | 6 |
HND, Degree or Professional Qualification | 7 |
15. Current economic status (please tick one):
Working full-time | 1 |
Working part-time | 2 |
Unemployed and receiving Job Seekers Allowance | 3 |
Unemployed but NOT receiving Job Seekers Allowance | 4 |
16. If currently WORKING please give the following information:
Job title: _______________________________________________________
What is your employer's business (for example hotel, shop, or manufacturing)?
______________________________________________________________
Date employment started: Year: ____________ Month___________________
Weekly hours worked: ____________________________________________
Gross weekly wage: ______________________________________________
17. If NOT currently WORKING have you ever worked?
18. If YES please give details of your last job
Job title: _______________________________________________________
What was your employer's business (for example hotel, shop or manufacturing)?
_______________________________________________________________
Date employment started: Year: ______________ Month: _________________
Date employment finished: Year: ______________ Month: ________________
Weekly hours worked: _____________________________________________
Gross weekly wage: _______________________________________________
Why did you leave? ________________________________________________
19. What benefits are you currently receiving (please tick all that apply)? :
Job Seekers Allowance | 1 |
Income Support | 2 |
Incapacity Benefit | 3 |
Working Tax Credit | 4 |
Child Tax Credit | 5 |
Child Benefit | 6 |
Housing Benefit | 7 |
Council Tax Benefit | 8 |
Other (please specify) | 9 |
20. Which of the following do you see as barriers to your ability to gain a job or enter a training or education course (please tick as appropriate)?
Inability to drive | 1 |
Lack of private transport | 2 |
Caring for child dependents | 3 |
Caring for non-child dependents | 4 |
Poor health | 5 |
Disability | 6 |
Lack of guidance | 7 |
Lack of skills/qualifications | 8 |
Lack of confidence | 9 |
Other (please specify) | 10 |
Attitudes
Please tick one box for each statement to show how much you agree or disagree with it.
| Strongly Agree | Agree | Neither agree or disagree | Disagree | Strongly Disagree |
21. I am very interested in obtaining a job. | | | | | |
22. I am very interested in obtaining a place on a training or education course. | | | | | |
23. I am confident that if I want a job I can get one. | | | | | |
24. If I want a job I know how to go about looking for one. | | | | | |
25. If I want a place on a training or education course I know how to obtain one. | | | | | |
26. If I want support to help me obtain a job I know who to approach. | | | | | |
27. I feel that I have the skills that employers are looking for. | | | | | |
28. I feel that I have the abilities that employers are looking for. | | | | | |
29. I feel that I could successfully complete a training course. | | | | | |
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