Please fill application in full, failure to do so may result in delay of interview
Job:
Name
Address
Postcode
Date of Birth
National Insurance Number
Nationality
Email Address
Mobile Number
Home Number
Contact Preferences EmailTelephonePost
Emergency Contact
Relationship to you
Telephone Number
Doctor's Name
Doctor's* Telephone Number
Doctor's* Surgery & Address
Name of contact
Company
Dates worked for company
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
AccountsAgricultureTransportWarehouseAutomotiveConstructionPublic ServicesFood & BeverageHealth ServicesHospitalityManufacturingAdmin / Office
Other (specify)
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
PB Recruitment Solutions Ltd (PBRS Ltd) is committed to a policy of equal opportunities for all work seekers.
Do you have any unspent* criminal convictions? ---YesNo
If Yes, state convictions and dates
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.
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?
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.
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) ---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?
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
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 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.