Referral Form Referral Form Self / Professional Referral Self ReferralProfessional Referral First name * Organisation * Telephone * Email * Full name * Contact Telephone Number * Email Address * Location "Town / City" * Are you Ex-Armed Forces? YesNoStill ServingReservistDependent/Spouse Are you Employed – FulltimeEmployed – Part-timeUnemployedUnemployed on State Benefits Do you hold a UK driving licence? YesNo Do you hold an HGV licence? NoCat C - Class 2Cat CE - Class 1HGV License Expired Do you hold or have you previously held a Driver CPC Card? YesNo Postcode * Date of Birth * Primary Support Required * ---HGV Driver TrainingHGV Refresher TrainingEmployment Support Do you consider yourself to have a health condition that affects your ability to work? YesNo Other In accordance with the General Data Protection Regulation, I agree that Veterans into Logistics may hold and use personal information about me to keep in touch with me for feedback and about future support. This information, including that contained in this form can be stored on both manual and computer files. It will be held securely and only accessed by authorised personnel.