Application Form Want to apply via a physical Form? If you would prefer to apply via a physical form, you can download a PDF here Download Now Please fill application in full, failure to do so may result in delay of interview Job: Your Details Name Address Postcode Date of Birth National Insurance Number Nationality Email Address Mobile Number Home Number Contact Preferences EmailTelephonePost Emergency Contact Information Emergency Contact Relationship to you Telephone Number Doctor's Name Doctor's* Telephone Number Doctor's* Surgery & Address References Name of contact Company Telephone Number Dates worked for company Other Information Do you have your own transport to get to work? ---YesNo Driving License ---YesNo Do you have any avian pets at home? ---YesNo Over 25 ---YesNo Areas of interest AccountsAgricultureTransportWarehouseAutomotiveConstructionPublic ServicesFood & BeverageHealth ServicesHospitalityManufacturingAdmin / Office Other (specify) Candidate Declaration I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to potential employers and hirers. I consent to references being requested from my previous workplace (s) and to references being passed onto potential employers and hirers. If, during the course of an assignment, the client (i.e. hiring company) wishes to employ me direct, I acknowledge that PB Recruitment Solutions will be either entitled to charge the Client and introduction fee, or to agree an extension of the hiring period with the Client. Your Name Applicant Agreement 1. Equal Opportunities Statement PB Recruitment Solutions Ltd (PBRS Ltd) is committed to a policy of equal opportunities for all work seekers. We will review on an ongoing basis all aspects of recruitment to avoid unlawful or undesirable discrimination. We will treat everyone equally irrespective of sex, sexual orientation, gender reassignment, marital or civil partnership status, age, disability, color, race, nationality, ethnic or national origin, religion or belief, political beliefs or membership or non-membership of a Trade Union and we place an obligation upon all staff to respect and act in accordance with the policy. PBRS Ltd shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment or in any terms of employment or terms of engagement for temporary workers. PBRS Ltd will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualifications and ability to perform the relevant duties required by the vacancy. 2. Criminal Convictions Certain types of employment and professions are exempt from the Rehabilitation of Offenders Act 1974 and in those cases, particularly where the employment is sought in relation to positions involving working with children or vulnerable adults, details for all criminal convictions must be given. The information given will be treated in the strictest of confidence and only taken into account where, in the reasonable opinion of PB Recruitment Solutions Ltd, the offence is relevant to the post to which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light. Do you have any unspent* criminal convictions? ---YesNo If Yes, state convictions and dates 3. Permission to work in the UK Do you have immigration permission to work in the UK? ---YesNo In line with “UK Visas and Immigration” guidance on the prevention of illegal working, we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by PB Recruitment Solutions Ltd for temporary work. 4. Health and Disability The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought. Do you have any health issues or disability which may make it difficult for you to carry out functions which are essential for the role you seek? ---YesNo Do you have any health issues or a disability relevant which may make it difficult for you to carry out functions which are essential for the role you seek? ---YesNo 5. Data Protection Statement The information that you provide on this form and on any CV given will be used by PB Recruitment Solutions Ltd to provide you work finding services. In providing this service to you, you consent to your personal data being included on a computerised database and consent to us transferring your personal details to our Clients (hirers and potential employers). We may check the information collected with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways permitted or required by law. 6. Candidate Declaration I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to potential employers and hirers. I consent to references being requested from my previous workplace (s) and to references being passed onto potential employers and hirers. If, during the course of an assignment, the client (i.e. hiring company) wishes to employ me direct, I acknowledge that PB Recruitment Solutions will be either entitled to charge the Client and introduction fee, or to agree an extension of the hiring period with the Client. Your Name Medical Questionnaire Confidential Please provide the following medical information in order for us to assess whether you are able to carry out the requirements of the job, to ensure your personal safety and for us to comply with any statutory requirements. This information will be treated in the strictest confidence and will only be used in compliance with the Data Protection Act 1998. Do you now, or have you ever suffered from any of the following? Please select Yes or No in respect of each condition. Dermatitis/Eczema ---YesNo Skin Cancer ---YesNo Gastric Ulcers ---YesNo Deafness/Ear Infections ---YesNo Recurrent Back Pain ---YesNo Sinusitis ---YesNo Tenosynovitis ---YesNo Chest Trouble ---YesNo Eye Disorders ---YesNo Bronchitis/Asthma ---YesNo Hay Fever ---YesNo Rheumatic Fever ---YesNo Heart Problems ---YesNo TB ---YesNo Heart Problems ---YesNo Sclerosis ---YesNo Rheumatism/Arthritis ---YesNo Alcohol dependency ---YesNo Fibrosis ---YesNo Fits (e.g. epileptic) ---YesNo Fainting attacks/giddiness ---YesNo Migraine ---YesNo Nervous breakdown ---YesNo Mental disorders ---YesNo Drug dependency ---YesNo If the answer is yes to any of these conditions, please give dates and details in the space provided below: Do any of your beliefs restrict you from working in any particular job or working environment? ---YesNo Would you be prepared to take a drug or alcohol test? (This is a requirement of some of our customers) ---YesNo Would you be prepared to participate in random searches at the client premises before/after or during your assignment? (This is a requirement of some of our customers) ---YesNo Do you have any health-related conditions that will require reasonable adjustments to be made to the selection process? ---YesNo UK and EC legislation puts the onus on employers to satisfy themselves that no food handler poses a hygiene risk to the product. Please answer the following questions if you will be working with food. At present, or in the last seven days, are you suffering from diarrhoea and/or vomiting? ---YesNo At present, or in the last seven days, are you suffering from stomach pain, nausea or fever? ---YesNo At present, are you suffering from skin infections of the hands, arms or face - e.g. boils, styes, septic fingers or discharge from eye / ear / gums / mouth? ---YesNo At present, are you suffering from jaundice? ---YesNo Do you suffer from recurring infections of the skin, ear or throat? ---YesNo Have you ever had typhoid or paratyphoid fever or are you now known to be a carrier of Salmonella Typhi or Para typhi? ---YesNo Are you a carrier of any type of Salmonella? ---YesNo In the last 21 days have you had contact with anyone, at home or abroad, who may have been a carrier of any type of salmonella? ---YesNo Have you been overseas in the last 6 weeks? ---YesNo How many times in the last 5 years have you had more than two consecutive weeks off sick from work? How many days have you had off sick in the last two years? Please give details of any medical treatment you are currently receiving? Please give details of any medication you are taking Have you had any serious illness or operation in the last 5 years? Please give details. ---YesNo Have you worked in an industry with high noise levels or been exposed to the use of hand held vibratory tools? Please give details and dates. ---YesNo Have you ever made a claim for Industrial Disease or injury? Please give details ---YesNo I certify that I have answered the questions in this questionnaire honestly and fully and that I am not otherwise aware of any physical or mental disability, which will or may affect my working capacity. I am aware that any false or incomplete statement may affect my appointment or future employment. Your Name I confirm that I am happy to be contacted by PB Recruitment Solutions in relation to this job application and for my application to be stored on file. Note: By clicking 'Submit Application' below, you are digitally signing the contents of this application.