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
Are we able to contact your references in advance? YesNo
Name of contact
Company
Dates worked for company
Please begin with the most recent employment.
Company Name
Job Title
Employed To-From
Reason for Leaving
Do you have your own transport to get to work? —Please choose an option—YesNo
Driving License —Please choose an option—YesNo
Do you have any avian pets at home? —Please choose an option—YesNo
Over 25 —Please choose an option—YesNo
AccountsAgricultureTransportWarehouseAutomotiveConstructionPublic ServicesFood & BeverageHealth ServicesHospitalityManufacturingAdmin / Office
Other (specify)
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
Please complete the below form fully. Failure to do so, may result in delay of receiving payment.
Date Of Birth
Gender MaleFemale
You need to select only one of the following statements A, B or C
A —Please choose an option—YesNo 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. B —Please choose an option—YesNo 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. C —Please choose an option—YesNo As well as my new job, I have another job or receive a State or Occupational Pension.
Name of Account Holder
Sort Code
Account Number
Name of Bank
Branch Address
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.
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.
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? —Please choose an option—YesNo
If Yes, state convictions and dates
Do you have immigration permission to work in the UK? —Please choose an option—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?
—Please choose an option—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?
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.
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
Skin Cancer
Gastric Ulcers
Deafness/Ear Infections
Recurrent Back Pain
Sinusitis
Tenosynovitis
Chest Trouble
Eye Disorders
Bronchitis/Asthma
Hay Fever
Rheumatic Fever
Heart Problems
TB
Sclerosis
Rheumatism/Arthritis
Alcohol dependency
Fibrosis
Fits (e.g. epileptic)
Fainting attacks/giddiness
Migraine
Nervous breakdown
Mental disorders
Drug dependency
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) —Please choose an option—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) —Please choose an option—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.
1.1 In this agreement the following definitions apply "Agency Worker" means The Candidate. "Assignment" means the period during which the Agency worker is supplied to provide services to the client; "Client" means the person, Firm or corporate body using the services of the Agency Worker; "Employment Business" means PB Recruitment Solutions Limited (registered company no 06085567), with trading address of Western Farm, Plantation Road, Aslacton, Norfolk NR15 2ER. "Working Week" mean an average of 48hrs each week calculated over a 17-week reference period.
1.2 References to the singular include the plural and references to the masculine include the Feminine and visa versa.
1.3 The headings contained in the agreement are for convenience only and do not affect their interpretation.
2.1 The Working Time Regulations 1998 (as amended)provide that the Agency Worker shall not work on an Assignment with the Client in excess of the Working Week unless s/he agrees in writing that this limit should not apply.
3.1 The Agency Worker hereby agrees that the Working Week limit shall not apply to the Assignment.
4.1 The Agency Worker may end this Agreement by giving the Employment Business 3 months notice in writing. 4.2 For the avoidance of doubt, any notice bringing the Agreement to an end shall not be construed as termination by the Agency Worker of an Assignment with the Client. 4.3 Upon the expiry of the notice period set out in clause 4.1 the Working Week limit shall apply with immediate effect.
5.1 This Agreement is governed by the law of England & Wales and is subject to the exclusive jurisdiction of the Courts of England & Wales.
Human Trafficking is regarded as the fastest growing criminal industry in the world, second in profitability only to the drugs trade. Organised criminality has identified that the exploitation of workers provides a lucrative business opportunity.
Responsible businesses now firmly place tackling modern slavery in their own organisation and their supply chains as a cornerstone of their business and human right strategy.
Particularly at risk of modern slavery are labour intensive and/or isolated industry sector characterised by a high proportion of migrant workers undertaking unskilled and irregular work often supplied through recruitment intermediaries. These sectors include food, garment and general merchandise manufacturing, agriculture and forestry, fishing, cleaning, catering, restaurant and bars.
We want you to have a positive experience working with us. We do not want you to feel harassed, discriminated against, bullied or coerced. At no time should you be asked for gift or money for work with us.
This confidential questionnaire will help us monitor your experience and take action where necessary.
Did you have to pay anyone to get a job?
Are you free to open and be paid into your bank account of your choice?
Do you feel that you can leave company of your own free will without suffering and penalty or detriment?
Do you have to pay anyone to ger regular work?
Do you have to pay anyone at the site you work at to get regular work?
Are you in control of your own bank account and able to deposit and take money as you wish?
Are you required to occupy, or pay for, specific accommodation, in order to get regular work?
Are you required tp pay for any other services or provide favours in order to get work or access to particular shift?
Have your original ID papers been withheld by anyone?
Do you feel that you can leave your home of your own free will without suffering and penalty or detriment?
Report it to the Gangmasters Licensing Authority on 0800 432 0804 or Modern Slavery Helpline on 0800 0121 700 or at https://modernslavery.co.uk/contact.html. Call the Police in an emergency on 999, or 101 if it is not urgent..
PB Recruitment Solutions operates an “Equal Opportunity” policy. To help us monitor the effectiveness of this policy, please complete this form and return it with your application form. A statement of our Equal Opportunity policy is included in the recruitment pack. This monitoring form will be detached from your application form and will be kept separately from the information to be used in the selection process.
The following categories are based on those used in the 2011 census as recommended by the EHRC. Please note the ethnic questions are not about nationality, place of birth or citizenship. UK citizens can belong to any of the ethnic categories indicated. How would you describe your national identity? Please select one of the following:
—Please choose an option—EnglishBritishWelshScottishNorthern IrishOtherPrefer not to disclose
Please check one below which best describes the ethnic category to which you belong:
—Please choose an option—White EnglishWelshScottishNorthern IrishBritishWhite IrishWhite GypsyWhite Irish TravellerWhite and Black CaribbeanWhite and Black AfricanWhite and AsianIndianPakistaniBangladeshiChineseBlack AfricanBlack CaribbeanArabOtherPrefer not to disclose
Please tick the appropriate box: MaleFemalePrefer not to disclose
Please state if you have any long-term physical or mental condition that affects your ability to carry out day-to-day activities. Please tick the appropriate box: YesNoPrefer not to disclose If yes, please confirm whether you require any reasonable adjustments
Age Date of Birth Prefer not to disclose
Please check your religion: No religion or BeliefBuddhistChristian (Church of England, Catholic, Protestant and all other Christian denominations)HinduJewishMuslimSikhOther ReligionPrefer not to disclose
Please check your sexual orientation: Heterosexual/straightGay woman/lesbianGay manBisexualOtherPrefer not to disclose
Are you married or in a civil partnership? please check your Marriage Status: YesNoPrefer not to disclose
I hereby give my consent to the Company to process the following information:
• Name • Date of birth • Contact details, including telephone number, email address and postal address • Experience, training and qualifications • CV • National insurance number • Identification • Salary Information • Doctors Details • Emergency Contact information
• Disability/health condition relevant to the role • Criminal conviction • Medical information incorporated within the medical questionnaire.
I consent to the Company processing the above personal data for the following purposes:
• For the Company to provide me with work-finding services. • For the Company to process with or transfer my personal data to their client/s in order to provide me with work-finding services. • For the Company to process my data on a computerised database in order to provide me with work-finding services.
I also consent to the Company processing my personal data with third parties for the purposes of internal audits and investigations carried out on the Company to ensure that the Company is complying with all relevant laws and obligations.
The consent I give to the Company will last for the time period I am registered with the agency.
I am aware that I have the right to withdraw my consent at any time by informing the Company that I wish to do so.
Signed Date
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 Equal Opportunities form - read here (opens in a new window)
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.
