Access to work application

Before you start

As part of your application, you will need to provide:

A copy of your employment contract or letter confirming an offer of employment. For self-employed people this can be evidence of upcoming work.
A description of how the aids or equipment will assist you in your role and any supporting documents that you may have.
Social Security will use any information that they already hold if this will support your request.
Details of the aids or equipment you require, including quotes.

If you do not have any of the above information and are unsure how to get it, please see the FAQ's section on the access to work page.

If you need help completing this form, please contact Access to Work on 222810 or via accesstowork@gov.gg.

The Committee for Employment and Social Security will process any personal data which you provide in accordance with the Data Protection (Bailiwick of Guernsey) Law, 2017. Further information about how your personal data is processed can be found at www.gov.gg/dp or alternatively you may call 01481 222500 and request a paper copy.

Access to work application
1. Declaration
  1. I have spoken with my employer and confirmed that they are willing for me to use the aids or equipment requested within the workplace. *
2. Your details
  1. First Name*
  2. Last Name*
  3. Date of birth*
  4. Social Security Number
  5. Your Social Security number will be two letters followed by six numbers (e.g. GY123456)
  6. Contact Number
  7. Email Address
  8. Address
    
    Address Line 1*
    
    Address Line 2*
    
    Address Line 3
    
    Parish/Town/City*
    
    Island/Country/State
    
    Post Code*
3. Employment Information
  1. What is your work status?*
    
    Employed
    
    Returning to work/Starting a Job
    
    Self Employed
  2. Unless you have a job to start your application will not be accepted.
  3. Name of business
    
    What type of work do you do?
    
    Number of employees (if any)
    
    Evidence of work (this may be confirmation of upcoming priced jobs or work schedule)
  4. Name of employer
    
    What type of work do you do?
    
    Employer's Address
    
    Evidence of work
4. Equipment Information
  1. Please provide details of the aid or equipment you need*
  2. How much is the aid or equipment expected to cost?*
  3. How will the aids or equipment support you in your role?*
  4. Please upload evidence of the aids or equipment, including a quote
  5. Do you have any supporting documentation that you would like to provide regarding the need for the aids or equipment?*
    
    Yes
    
    No
  6. Please upload a copy of the supporting documentation
  7. We will access any information that Social Security already hold which will support your application for aids or equipment.
5. Closing Declaration
  1. I confirm the information provided in this application is true and correct*

St Peter Port & St Sampson

All Other Parishes