Inclusiv Retea de centre suport pentru integrarea persoanelor

vulnerabile pe piata muncii n 6 regiuni din Romnia POSDRU/165/6.2/S/142913Investete n oameni!Proiect cofinanat din Fondul Social European prin Programul Operaional Sectorial Dezvoltarea Resurselor Umane2007-2013Axa prioritar 6 Promovarea incluziunii socialeDomeniul major de intervenie 6.2 mbuntirea accesului i a participrii grupurilor vulnerabile pe piaa muncii Nr._____ din _____________

ANCHETA SOCIAL

Realizat de asistentul social _______________________________________

Locul i data ____________________________________________________

Persoane prezente _______________________________________________

Scopul _________________________________________________________

I. Date de identificare a beneficiarului

Nume i prenume: _______________________________________________

Locul i data naterii: _____________________________________________

CNP: __/__/__/__/__/__/__/__/__/__/__/__/__/ C.I. _____________________

Domiciliul legal: _________________________________________________

Domiciliul n fapt: ________________________________________________

Stare civil: ____________________________________________________

Studii: __________________________Ocupaia: _______________________

Etnia: __________________________ Religia: ________________________________

II. Date despre familie:

Date despre membrii familiei:Nume i prenume: _______________________________________________

Locul i data naterii: _____________________________________________

CNP: __/__/__/__/__/__/__/__/__/__/__/__/__/ C.I. _____________________

Domiciliul legal: _________________________________________________Domiciliul n fapt: ________________________________________________

Stare civil: ____________________________________________________

Studii: ___________________________Ocupaia: ______________________

Etnia: ____________________________Religia: _______________________________Date desprefamilie:Nume i prenume: _______________________________________________

Locul i data naterii: _____________________________________________

CNP: __/__/__/__/__/__/__/__/__/__/__/__/__/ C.I._____________________

Domiciliul legal: _________________________________________________

Domiciliul n fapt: ________________________________________________

Stare civil: ____________________________________________________

Studii: ___________________________ Ocupaia: _____________________

Etnia: ____________________________ Religia: _______________________

Date despre copiii din familie

Nr.

crt.Nume i prenumeData nateriiOcupaia

Locul unde se afl copilul: familie/instituieObservaii

1.

2.

3.

4.

5.

Date despre alte persoane care locuiesc la aceeai adresNr.crt.Nume i prenumeVrstaStare civilOcupaie

1.

2.

3.

III. Istoricul social al beneficiarului____________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________IV. Istoricul profesional al beneficiarului ____________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________V. Starea de sntate______________________________________________________________

______________________________________________________________

______________________________________________________________

VI. Situaia material/financiar

Locuina

Proprietate personal: ( da ( nu Numarul de camere: ______

Electricitate Ap curent nclzire Telefon

Starea de igien: Satisfctoare Nesatisfctoare

Suprafaa de teren cultivat (tipul culturii): ______________________________

Animale: ________________________________________________________

Alte proprieti: ___________________________________________________

Venituri

Stabile: _________________________________________________________

Ocazionale: _____________________________________________________

VII. Relaiile n familie, comunitate, colegialeRelaii n familie: _________________________________________________

_______________________________________________________________

_______________________________________________________________

Relaiile n comunitate: ____________________________________________

_______________________________________________________________

_______________________________________________________________

Relatii colegiale de la ultimul loc de munca: ________________________________

___________________________________________________________________

___________________________________________________________________VIII. Observaii

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IX. Concluzii i recomandri___________________________________________________________________

___________________________________________________________________

______________________________________________________________________________________________________________________________________

___________________________________________________________________

___________________________________________________________________

______________________________________________________________________________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Asistent social,