Application Form

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

Your Details




Date of Birth

National Insurance Number


Email Address

Mobile Number

Home Number

Upload CV

Contact Preferences

Emergency Contact Information

Emergency Contact

Relationship to you

Telephone Number

Doctor's Name

Doctor's* Telephone Number

Doctor's* Surgery & Address


Name of contact


Telephone Number

Dates worked for company

Other Information

Do you have your own transport to get to work?

Driving License

Do you have any avian pets at home?

Are you over 18?

Are you available to work nights?

Are you available to work weekends?

Employment desired

Availability date

Notice Period

Areas of interest

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?

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.

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

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