Referral Form

Please complete the following details and submit

Client Personal Details

*APEX Unit Referral to
*Firstname		Ethnicity - Main Classification
*Lastname		Ethnicity - Sub Classification
*RSO/Schedule 1 Client		Other Ethnicity
Title
*Gender
Date of birth
Marital status
National Insurance No

Client Contact Details

Street		Preferred contact mode
		Next of Kin
Area/Town		Home Telephone
City/County		Mobile Telephone
Postcode		Email

Client Background

Accessed Apex before		Employment Status
Details		If other(please specify)
Do you have any special needs
Have you ever served in the Armed Forces
If yes what was your Tag No		Other (Give details)
User consent to referral obtained
information given to Apex Scotland
If a school pupil what year

Issues/Special Notes

Reason for referral

Notes/specific group or 1-2-1 work

Incident leading to referral

Known barriers to engagement

History of violence or sexual offending

Special Instructions

Referrer Details

Date of referral
Date referral recieved
Name of referrer
Company/Organisation
Company telephone number
Company email address
Company Address

Background Information Request (For RSO and Schedule 1 Cases ONLY)

Apex Scotland promotes a “best and safest” practice approach which is underpinned by its policy and guidelines of service delivery.
Apex Scotland is committed to working in partnership with Social Work, Police and other agencies that provide services for Sex Offenders and Schedule 1 Offenders.
In order for Apex Scotland to provide a specialist employability secondary support service which complements the statutory agencies work with these types of offenders, we require the following information on the client you are referring.
Please provide information. On receiving this information we will be able to carry out a Risk Assessment prior to working with the client.
Thank you for your co-operation.
Offence Frequency		Offence History
Known Victim / Gender Group		Victim Age
Relationship to Victim		Offending Programmes Attended or About To Be Attended
Client’s Attitude to Intervention/Challenges		Current Order
Any Licence Conditions		Is Client on Sex Offender Register and/or Excluded From Working With Children List
Outcome of Any Risk Assessment / Any Special Interviewing Arrangements in Place		Other Areas of Possible Employment Restrictions, For example IT Access, Geographical Travel, Children’s Hearing Restrictions

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