1. THE JOBSEEKER
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Last name:
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First name:
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Middle name:
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Date of birth:
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Aliases including nicknames:
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Gender:
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Current address:
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Postcode:
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Telephone number:
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(h)
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(m)
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Disability / Diversity considerations:
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2. NOTIFYING AGENCY
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Notifying agency:
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Probation / Police
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Name:
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Grade:
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Office:
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Telephone number(s):
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(w)
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(m)
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Email address:
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Date Jobseeker informed of Jobcentre Plus notification:
(In exceptional circumstances where Jobseeker not informed, give date of discussion with Jobcentre Plus Designated Officer / SPOC)
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Does the offender present a risk of serious harm to Jobcentre Plus staff or other employment and training providers?
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YES / NO
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If YES:
Describe the nature of the risk of serious harm and contact the Jobcentre Plus Designated Officer / SPOC to discuss.
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3. MAPPA POINT OF CONTACT
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Name:
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Grade:
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Office:
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Telephone number(s):
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(w)
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(m)
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Email address:
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4. INITIAL RESTRICTIONS / CHANGE OF RESTRICTIONS
which will affect the employment / training of the Jobseeker
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Initial Restrictions / Change of Restrictions [delete as appropriate]
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Date restriction ends
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Date notification emailed to JCP Designated Officer/SPOC:
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Date by which JCP Designated Officer / SPOC should contact lead agency to discuss (within 5 working days, if notification restriction/change of restrictions):
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5. NO RESTRICTIONS APPLY
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complete only when there is serious concern regarding employment and the need to protect the public from serious harm
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Date discussed with Jobcentre Plus Designated Officer / SPOC:
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Information shared:
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