Kickstart Tees Valley

Employer Details:

Business Name

Contact Name

Telephone Number

Email address

Business/Company Registered Address including Post Code*

Is the Business a Limited Company?
YesNo

Are you registered Sole Trader?
YesNo

Please enter your UTR (Unique Tax Reference)?

Do you have a business bank account?
YesNo

In order to progress your application please would you confirm you are happy for us to contact you to obtain further details?
YesNo

Local Authority Area
DarlingtonHartlepoolMiddlesbroughRedcar and ClevelandStockton-on-Tees

Company Sector:

How long has your Company been trading?

If your company is VAT registered please provide its VAT number:

Employer Liability Insurance Policy No:

Placement Details

Number of Job Placements you are offering

Job titles of Job Placements

Are the Job Placements at more than one workplace?
YesNo

Workplace Address for Job Placement(s) including Post Code: (if different from registered address, list all the placements and their prime location)

Planned Start Date of job placement(s):

Details of any additional costs you’d incur and wish to be incorporated into the application e.g. uniform, supervision, travel support

Employer’s Commitments - Declaration

I am duly authorised by the above business to make the following declaration and I understand that if any part of this declaration is false, funding may be suspended or withdrawn. This could include seeking the recovery of any paid funding to the business under the programme.

1. The Kickstart placement(s) listed in this application:
   1. are not included in any other arrangement or application for Kickstart funding;
   2. are located within Tees Valley.
   3. are new roles that will not displace existing employees or contractors.
   4. Are funded by the Kickstart Scheme grant and would not exist without this funding.
2. The business will employ the named Kickstart participant(s) for not less than 25 hours per week for a 6-month duration which will be funded through the Kickstart Scheme Grant
3. On behalf of the Business I COMMIT:
   1. to providing the number of Kickstart Placements Specified in this application.
   2. to supporting the Kickstart Participant(s) to develop their skills and experience as outlined in the initial application.
   3. to provide TVCA with a copy of the job description for the Job Placement(s) when requested.
4. I will inform Tees Valley Combined Authority:
   1. When I have offered an individual a Kickstart placement.
   2. if that individual leaves or is dismissed or fails to attend the appropriate learning;
5. I will ensure all required information is supplied to Tees Valley Combined Authority, including timesheets and details of Job Placement(s), as and when required.

DATA PROTECTION

The Tees Valley Combined Authority (TVCA, we or us) takes data protection very seriously and it is import that you understand how the information we collect will be used and stored. Further information can be found in our Privacy Notice (https://teesvalley-ca.gov.uk/wp-content/uploads/2020/04/Tees-Valley-Combined-Authority-Privacy-Notice.pdf).

This Programme is funded by the Department of Work and Pensions (DWP). We are required to share information about your participation in the programme with DWP. We will use the information provided in this form or given to us while you are funded by this programme for the purposes of managing and monitoring the programme and providing reports to our decision-making bodies and DWP. The information will be retained and disposed of in accordance with our Retention Policy.

Print Name

Date (format must be DD/MM/YYYY)

By submitting this form you are accepting that Tees Valley Business may require a signature from you at a later date.