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CUSTOMER CONSENT FORM
Employment Programmes - consent to share information
[Name of Provider] is working with Jobcentre Plus programme participants on behalf of the Department for Work and Pensions (DWP) to help these participants to increase their skills to help them find and keep work. [Provider] may claim a payment from DWP for every Jobcentre Plus participant who finds work while or after participating in a programme.
To claim a payment from DWP [Provider] may need to confirm details of your employment
To validate these claims DWP may need to confirm details of your employment. Where appropriate, this may involve confirming details with each of your employers.
To achieve this, [Provider], DWP and your future employers need your consent to share information about you as follows:
Stage 1: [Provider] will give your name and national insurance number to your future employer.
Stage 2: Your employers will use your name and national insurance number to identify you, so that they can confirm to [Provider] some or all of the following information:
•	The date you began each period of your employment;
•	Whether your employment is continuing;
•	If not continuing, the date each period of your employment ended;
•	whether you were employed during a specific period;
•	the number of hours you worked each week;
•	the amount of your earnings each week;
•	Your employee number or other unique identifier.
•	This information can only be provided where company payroll/structures exist, and therefore if no payroll numbers or detail is present, this information cannot be supplied.
Stage 3: To validate payment claims from [Provider], DWP may contact your employer using your name and national insurance number to ask for the information listed at stage 2. It will use this information to:
•	Check if the information given to it by the [Provider] is correct; and
•	Evaluate the programme.
DWP will store your information securely for audit purposes.
If you do not give consent, this will not affect your entitlement to participate in the programme, or any job offer or employment obtained. You can write to [Provider] at any time to withdraw your consent and this will not affect your placement on the programme or any employment or offer of employment made.
Participant name…………………………………………. (Please print name in full)
I give consent for [Provider], my future employer and DWP to share information as described in stages 1 to 3 above.
I confirm that:
I have read the information above and understand why this information sharing is needed and how this information will be used.
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 [Provider] 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 [Provider]

Signature …………………………………….
Date………………………………