Microsoft Word - FoI 2388 - 02.09.111.doc

    The Work Programme – Customer Declaration 

 When you first made a claim to benefit you signed the Department for Work and 
Pensions (DWP) Confidentiality Statement which provided you with the assurance that 
DWP will handle your personal data fairly and lawfully.  Following this, and in line with 
the requirements of the Data Protection Act, to enable us to deliver the most effective 
services to you, there is a certain minimum amount of information that we require. 
Therefore  when  you  join  us,  we  take  a  record  of  your  Name,  address,  National 
Insurance Number and which benefits you are receiving. 

 When you obtain employment, we also record details of your employer and job. This 
information is stored securely. There are some instances where it will be important to 
share this information and we need your consent to do this. For example, we may 
share some of these details with DWP and other organisations in order to assist us to 
identify appropriate training, set up job interviews and help you secure employment. 

 Please sign, date and print your name below to acknowledge that you have read 
and understood the above. 
I give consent for G4S Welfare to Work, to share information as described above.  

 I understand that: 

 
  If I am in receipt of any benefits, my entitlement to these benefits will not 
depend on whether I choose to give consent or not. 
  My placement on any programme with G4S Welfare to Work and any 
employment or future offer of employment will not depend on whether I choose 
to give consent or not. 
  I can withdraw my consent at any time by writing to G4S Welfare to Work. 

 Signed …………………………………………………….  Date ………………………….. 

 Customer name………………………………………….  (Please print name in full) 

  

Employer Contact 
 
When you succeed in moving into work, we would like permission to contact your 
employer.  This is to help secure funding for our programmes and to maintain our audit 
trail.  Your information will not be passed on to any other organisations.  If you consent 
to us contacting your employer when you move into work, please sign, date and print 
your name below. 
I give consent for G4S Welfare to Work, to share information as described above.  

 Signed …………………………………………………….  Date ………………………….. 

 

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Customer name………………………………………….  (Please print name in full) 

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