Please complete the below form fully. Failure to do so, may result in delay of receiving payment.
Employee's personal details
Date Of Birth
National Insurance Number
You need to select only one of the following statements A, B or C
This is my first job since last 6th April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.
This is now my only job but since last 6th April I have had another job, or received taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive a State or Occupational Pension.
As well as my new job, I have another job or receive a State or Occupational Pension.
Bank Account Information for Payment of Wages
Name of Account Holder
Name of Bank
If the account is not in your name, I hereby authorise my wages to be paid into this account and agree to notify payroll if there is any change (in writing) and do not hold the company responsible if the monies are no passes to me by the account holder.
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?
If Yes, state convictions and dates
3. Permission to work in the UK
Do you have immigration permission to work in the UK?
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?
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?
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.
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.
|Recurrent Back Pain|
|Fits (e.g. epileptic)|
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?
Would you be prepared to take a drug or alcohol test?
(This is a requirement of some of our customers)
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)
Do you have any health-related conditions that will require reasonable adjustments to be made to the selection process?
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?
At present, or in the last seven days, are you suffering from stomach pain, nausea or fever?
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?
At present, are you suffering from jaundice?
Do you suffer from recurring infections of the skin, ear or throat?
Have you ever had typhoid or paratyphoid fever or are you now known to be a carrier of Salmonella Typhi or Para typhi?
Are you a carrier of any type of Salmonella?
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?
Have you been overseas in the last 6 weeks?
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.
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.
Have you ever made a claim for Industrial Disease or injury? Please give details
Upload your CV
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.
I have read and agree to the 48 Hour Opt Out (optional) read here (opens in a new window)
- I have read and agree to the Important Information - read here (opens in a new window)
- I have read and agree to the Acknowledgement of Contract for Services - read here (opens in a new window)
- I have read and agree to the Modern Day Slavery PDF - read here (opens in a new window)
- I have read and agree to the Equal Opportunities form - read here (opens in a new window)
Note: By clicking 'Submit Application' below, you are digitally signing the contents of this application.