Kickstart Scheme Funding Application
Please complete this form to apply for funding under the Kickstart Scheme. You can use one form to apply for multiple job placements in your organisation. Rock and Road will submit applications in batches to the Department for Work & Pensions who will make a final decision on each application.
Full Name of person submitting application
Job Title of person submitting application
Confirmation of Email Address of person submitting application
Phone number of person submitting application
Address of Company/Employer/Organisation
Postcode of Company/Employer/Organisation
Companies House / Charity Commission number
Guidance: If you are not a Company or Charity, please state what type of employer you are (i.e. public sector, unincorporated association).
How many Kickstart Scheme job placements do you wish to apply for?
Guidance: There is no limit to the number of job placements you can apply for, but you must be ready to accept applications and offer a prompt start date for any you are applying for now.
Please list the proposed Job Title and start date for each job placement you are applying for.
Guidance: Each job placement must be on a separate line and be numbered (i.e. Job 1. Office Assistant, November 2020).
In which region will these job placements be based? Please tick all that apply
East of England
Yorkshire and the Humber
The job placements created with Kickstart funding must be new jobs. They must not: replace existing or planned vacancies, cause existing employees or contractors to lose or reduce their employment. Does your vacancy meet these requirements?
For any assistance with this form or general enquiries kindly contact Rock and Road on 01524 932100 or
I agree that Rock and Road will act as our Representative Organisation / Intermediary
I believe that the information provided is true and to the best of my knowledge and awareness.
I can confirm that I am an authorised official of the company and can submit this application on behalf of the company.
I can confirm that I am fully aware and understand the government criteria for Kickstart grants and make this application with that knowledge.
I can confirm that this is our only application for a Kickstart grant and we are not awaiting to hear on any other, nor will we be submitting any additional applications until we hear the outcome of this.
A copy of your responses will be emailed to the address you provided.
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