Please fill application in full, failure to do so may result in delay of interview

    Your Details

    Name

    Address

    Postcode

    Date of Birth

    National Insurance Number

    Nationality

    Email Address

    Mobile Number

    Home Number

    Contact Preferences



    Emergency Contact Information

    Emergency Contact

    Relationship to you

    Telephone Number

    Doctor's Name

    Doctor's* Telephone Number

    Doctor's* Surgery & Address



    References

    Are we able to contact your references in advance?

    Reference 1

    Name of contact

    Company

    Telephone Number

    Dates worked for company

    Reference 2

    Name of contact

    Company

    Telephone Number

    Dates worked for company



    Employment History

    Please begin with the most recent employment.

    Most recent

    Company Name

    Address

    Telephone Number

    Job Title

    Employed To-From

    Reason for Leaving

    Previous job

    Company Name

    Address

    Telephone Number

    Job Title

    Employed To-From

    Reason for Leaving

    Job 3

    Company Name

    Address

    Telephone Number

    Job Title

    Employed To-From

    Reason for Leaving

    Job 4

    Company Name

    Address

    Telephone Number

    Job Title

    Employed To-From

    Reason for Leaving



    Other Information

    Do you have your own transport to get to work?

    Driving License

    Do you have any avian pets at home?

    Over 25

    Areas of interest

    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



    Payment Information

    Please complete the below form fully. Failure to do so, may result in delay of receiving payment.

    Employee's personal details

    Name

    Address

    Postcode

    Date Of Birth

    Gender

    National Insurance Number



    Employee Statement

    You need to select only one of the following statements A, B or C

    A
    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
    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
    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

    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.

    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?

    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.

    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

    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

    Heart Problems

    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)

    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




    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






    48 Hour Opt Out Agreement

    1. Definitions

    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 unit 1, Bunns Bank Industrial Estate, Attleborough Norfolk, NR15 1QD.
    "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. Restrictions

    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. Consent

    3.1 The Agency Worker hereby agrees that the Working Week limit shall not apply to the Assignment.

    4. Withdrawal of Consent

    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. The Laws

    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.

    Your Name






    Modern Day Slavery

    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..

    Your Name





    Equal Opportunities Monitoring Form

    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.

    Your Name

    1) Ethnic Category

    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 check one below which best describes the ethnic category to which you belong:


    2) Gender

    Please tick the appropriate box:

    3) Disability

    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:

    If yes, please confirm whether you require any reasonable adjustments

    4) Age

    Age Date of Birth

    5) Religion or belief

    Please check your religion:

    6)Sexual Orientation

    Please check your sexual orientation:

    7) Marriage Status

    Are you married or in a civil partnership? please check your Marriage Status:






    Additional

    Your Name






    Note: By clicking 'Submit Application' below, you are digitally signing the contents of this application.