Application Form Please complete this 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 Upload CV 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 Are you over 18? ---YesNo Are you available to work nights? ---YesNo Are you available to work weekends? ---YesNo Employment desired ---TempPermEither Availability date Notice Period Areas of interest AccountsAgricultureTransportWarehouseAutomotiveConstructionPublic ServicesFood & BeverageHealth ServicesHospitalityManufacturingAdmin / Office Other (specify) 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. 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 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.