CANDIDATE APPLICATION FORM
APPLICANT Please complete in INK using BLOCK CAPITALS
Title ( Mr, Mrs, Miss )Forename(s)
Surname
Home Address
Tel Number ( Home )
Tel Number ( Mobile )
Date Of Birth
National Insurance Number
Do you have a current driving licence?
For what classes of vehicle?
No of penalty points endorsed on licence?
Your Living accommodation eg owner, occupier, living with parents etc
Bank/Society Name
Bank/Society Branch
Address
Sort Code
Account Number
Account Name
Education History & Examination results/qualifications obtained ( continue over page )
Employment History ( Including Dates, Job Titles, Salary & Duties )
Please provide details of a minimum of two referees we may approach
GP Name
GP Address
GP Tel Number
Height
Weight
Do You Smoke?
In case of an emergency please provide details of someone we should contact on your behalf – Name & Address
Home Tel Number
Mobile Tel Number
Have you ever been convicted of a criminal offence? If yes give details
My signature on this application confirms that the information provided on this form and within my CV, if applicable, is both truthful and accurate. I have omitted no facts that could affect my future employment. I understand that any engagement entered into is subject to documentary evidence of my right to work in the uk, verification of any professional qualifications and subject to satisfactory references. I consent to any sensitive or personal date, disclosed as part of my application, being used in connection with the search for work, subject to relevant Data Protection legislation. I will inform Essex Recruitment Services Limited immediately of any circumstances that may affect my work, such as changes to health, subsequent pending prosecutions or convictions which may arise whilst I am registered for permanent or temporary work. I understand that Essex Recruitment Services Limited has the right to request a Criminal Record Bureau Disclosure where they consider it necessary and the details from this or any other police checks provided may be forwarded to a potential employer.
NameSignature
Date
OCCUPATIONAL HEALTH ASSESSMENT
MEDICAL HISTORYGeneral Health Questions / Yes / No / DETAILS
Are you in good health?
How much time have you lost from work due to illness in the last five years?
Have you ever been treated in hospital for serious illness or surgery?
Have you been treated in hospital during the last 12 months?
Do you have any physical disabilities that could affect your ability to carry out your assignment?
Have you ever left, been retired or denied a job on health grounds?
Have you ever been denied a driving licence on health grounds?
Are you a registered disabled person?
Have you any disability related to your physical or mental health?
Have you ever suffered from any mental illness, psychological or psychiatric problems?
Do you get discomfort or pain in the chest or shortness of breath on exercise?
Have you ever had any problems with your joints, including pain, swelling or stiffness?
Do you have difficulty in moving rapidly over short distances?
Would you have difficulty looking over either shoulder?
Do you need to wear glasses or contact lenses?
Do you have difficulty with your eyesight which is not corrected by glasses or contact lenses?
Have you any problems working with Visual Display Units?
Have you any problems working in confined spaces/using lifts?
Do you have any difficulty hearing normal conversations?
Are you taking any medication that makes you dizzy or drowsy?
Do you have a medical condition affected by changing sleeping patterns or affecting day time sleep?
Have you suffered from any alcohol or drug related illness or had an alcohol or drug problem?
Are you having or awaiting any treatment at the moment?
What is the date of your last chest x-ray?
Are you receiving Medicines, Pills or Tablets from a doctor or on prescription?
Have you ever suffered from any of the following?
Heart Problems/Circulatory Illness/Hypertension
High or Low Blood Pressure
Diabetes
Asthma/Hay Fever
Bronchitis/Pneumonia/Pleurisy
Tuberculosis
Epilepsy/Fainting Attacks/Blackouts/Fits/Sudden Collapse
Headaches/Migraine
Psychiatric Illness/Anxiety/Despression
Dermatitis/Skin Sensitivity/Psoriasis/Eczema/Allergies
Back injury/Back Problems/Back Pains
Recurrent Infections eg Sore Throats/Ear Infections/Eye Infections
Hepatitis/Jaundice
Have you ever been tested or inoculated for any of the following?
Varicella
Tuberculosis including BCG
Heaf, Mantoux or Tine
Rubella ( German Measles )
Poliomyelitis
Hepatitis A
Hepatitis B
Hepatitis B Antibodies Date & Result
HIV
Tetanus
Typhoid
Any Other conditions or work adjustments you consider appropriate?
Date: …………………..
Dear ………………………
We are delighted you have decided to register with Essex Recruitment Services Limited and we hope this will be the start of a mutually beneficial business relationship.
We have pleasure in attaching the following documents:-
Copy of our Health and Safety Policy
Copy of our Immigration Policy
Copy of Terms of Engagement for PAYE/Ltd/Composite company workers ( delete as appropriate )
If there are any points in this letter/pack you would like to discuss please do not hesitate to us on …………………… and ask for …………………………….
Once again, a very warm welcome to Essex Recruitment Services Limited.
Kind Regards
………………………………………….
For and on behalf of Essex Recruitment Service Limited
HEALTH AND SAFETY POLICY
General Company Policy
It is the policy of the Company to provide and maintain safe and healthy working conditions, equipment and systems of work for all our employees and temporary workers and to provide such information and training as they need for this purpose.
Appropriate preventative and protective measures are, and will continue to be, implemented following the identification of work-related hazards and assessment of the risks related to them. It is also the policy of the Company to ensure that its business is conducted in a manner so as to reduce the risks to members of the public. The company may require you to attend such training programmes in order to meet the aims of the Company.
The Company accepts its responsibility for health and safety of other persons who may be affected by the Company’s activities.
The allocation of duties for safety matters and the identity of persons appointed with particular responsibilities are set out in this policy.
This policy will be kept up to date, to reflect changes in the nature and size of the business. To ensure this, the policy and its effectiveness will be reviewed annually.
Company’s responsibility
It is the duty of management to ensure the following:
Providing and maintaining systems of work that are safe and without risk to health
Ensuring safety and absence of risks to health in connection with handling, storage and transport
Providing information, instruction, training and supervision
Maintaining all places of work in a safe condition
Providing and maintaining a safe working environment
Your responsibility
All employees and workers have a duty in law to act responsibly and to take reasonable care for the health and safety at work of both themselves and their colleagues. This duty can be carried out by
Working safely and efficiently
Using any protective equipment provided and meeting statutory obligations
Reporting incidents that have lead to injury or damage
All such incidents must be recorded and copied to the Human Resources Officer using the internal report form. Any failure to adhere to the Company Health and Safety Policy and Procedures will be considered a serious disciplinary offence and is one which may lead to dismissal
Adhering to the Company procedures for securing a safe workplace. Individuals will be nominated to undertake health and safety duties as required.
Working Practices
You must not operate any item of equipment unless trained, and authorized to do so
You must not remove any guarding from equipment used or deviate from your authorized usage of the equipment
You must report immediately any equipment defect, and never attempt repair
You must undertake all duties as instructed and never deviate
In case of workers attending work on external sites, do not commence work until you have received a health and safety induction from their site manager
Hazards/Warning Signs and Notices
You must comply with all hazard/warning signs and notices displayed on the premises
Working Conditions/Environment
You must make proper use of all equipment and facilities provided to control working conditions/environment
You must ensure you keep your work areas clear/tidy
You must dispose of waste/scrap in the appropriate receptacles
Protective Clothing & Equipment
You must wear protective equipment where required
You must never obstruct any fire escape route, fire equipment or doors
Health
You must report any medical condition that could affect the safety of yourself or others
You must follow all rules pertaining to no smoking areas
Accidents
The Company is obliged by law to keep record showing details of all accidents, which occur on the premises. Therefore all accidents, however minor, to both employees and clients, must be reported immediately. If any accidents are sufficiently serious to warrant hospital treatment, these must also be reported to the local authority. A form must be completed
Fire and Emergency
You must observe the evacuation procedures laid down in the event of a fire or any other emergency situation
You must be aware of the location of the emergency exists, assembly points and first aid kit
Procedures to be carried out in the event of a fire or emergency will be found on the notice board
Thank you for your cooperation
ESSEX RECRUITMENT SERVICES LIMITED – IMMIGRATION POLICY FOR PAYE WORKERS
From 1st May 2004 a person will only be allowed to work for our company if they provide us
with the documents outlined in any of the categories B-V.
B A United Kingdom passport describing the holder as a British citizen or as a citizen of the
United Kingdom and Colonies having the right of abode in the United Kingdom.
C A passport containing a certificate of entitlement issued by, or on behalf of, the
Government of the United Kingdom, certifying that the holder has the right of abode in
the United Kingdom.
D A passport or national identity card, issued by a State which is a party to the European
Economic Area Agreement, or any other agreement forming part of the Communities
Treaties which confers rights of entry to or residence in the United Kingdom, which
describes the holder as a national of a State which is a party to that Agreement.
E A United Kingdom Residence Permit issued to a national of a State which is a party to
the European Economic Area Agreement, or any other agreement forming part of the
Communities Treaties which confirms that the holder has rights of entry to or residence
in the United Kingdom.
F A passport or other travel document, or a residence document issued by the Home
Office which is endorsed to show that the holder has a current right of residence in the
United Kingdom as the family member of a named national of a State which is a party to
the European Economic Area Agreement, or any other agreement forming part of the
Communities Treaties which confers rights of entry to or residence in the United
Kingdom, and who is resident in the United Kingdom.
G A passport or other travel document endorsed to show that the holder is exempt from
immigration control, has Indefinite Leave to Enter or Remain in the United Kingdom or
has no time limit on their stay.
H A passport or other travel document endorsed to show that the holder has current leave
to enter, or remain in, the United Kingdom and is permitted to take the employment in
question, provided that it does not require the issue of a work permit.
I A passport or other travel document endorsed to show that the holder is a student and
has current leave to enter, or remain in, the United Kingdom and is permitted to take the
employment in question, provided that it does not require the issue of a work permit.
J An asylum seekers registration card which indicates that the holder is entitled to take
employment in the United Kingdom.
K A passport or national identity card, issued by the Czech Republic, Estonia, Hungary,
Latvia, Lithuania, Poland, Slovakia or Poland. AND a completed Worker Registration
Scheme application form.
Reference to ID code K
When employing any national from one of the 8 countries listed above (referred to as A8
members in the Home Office documents), you must ask them to produce a national
passport or national identity card and then take a copy of the original document for our
records.
It is then ok to supply this temp to your Client and set them up for payroll purposes.
However, if you engage such nationals you need to bare the following in mind.
It is necessary for all A8 nationals to register with the Home Office under the new
Workers Registration Scheme.
Application forms for the above scheme are available from
Version 2
It is necessary for you to get all A8 national temps to complete the above application
form BEFORE commencing employment with our Company.
You must retain a copy of this completed form for our records. If you continue to employ
an unregistered national from one of these eight countries without retaining a copy of
their application form you may commit a criminal offence under new regulations. The
maximum penalty on conviction will be £5,000. Similarly, if the Home Office notifies you
that your employee’s application has been refused and you continue to employ that
person, you may also commit an offence.
M A document issued by a previous employer, Inland Revenue, the Department for Work
and Pensions, Jobcentre Plus, the Employment Service, the Training and Employment
Agency (Northern Ireland) or the Northern Ireland Social Security Agency which contains
the National Insurance number of the person named in the document.
AND a birth certificate issued in the United Kingdom which specifies the names of the
holder’s parents.
N A document issued by a previous employer, Inland Revenue, the Department for Work
and Pensions, Jobcentre Plus, the Employment Service, the Training and Employment
Agency (Northern Ireland) or the Northern Ireland Social Security Agency which contains
the National Insurance number of the person named in the document.
AND a birth certificate issued in the Channel Islands, the Isle of Man or Ireland.
P A document issued by a previous employer, Inland Revenue, the Department for Work
and Pensions, Jobcentre Plus, the Employment Service, the Training and Employment
Agency (Northern Ireland) or the Northern Ireland Social Security Agency which contains
the National Insurance number of the person named in the document.
AND a certificate of registration or naturalisation as a British citizen.
Q A document issued by a previous employer, Inland Revenue, the Department for Work
and Pensions, Jobcentre Plus, the Employment Service, the Training and Employment
Agency (Northern Ireland) or the Northern Ireland Social Security Agency which contains
the National Insurance number of the person named in the document.
AND a letter issued by the Home Office, to the holder, which indicates that the person
named in it has been granted Indefinite Leave to Enter or Remain in the United
Kingdom.
R A document issued by a previous employer, Inland Revenue, the Department for Work
and Pensions, Jobcentre Plus, the Employment Service, the Training and Employment
Agency (Northern Ireland) or the Northern Ireland Social Security Agency which contains
the National Insurance number of the person named in the document.
AND an Immigration Status Document issued by the Home Office to the holder,
endorsed with a United Kingdom Residence Permit, which indicates that the holder has
been granted Indefinite Leave to Enter or Remain in the United Kingdom.
S A document issued by a previous employer, Inland Revenue, the Department for Work
and Pensions, Jobcentre Plus, the Employment Service, the Training and Employment
Agency (Northern Ireland) or the Northern Ireland Social Security Agency which contains
the National Insurance number of the person named in the document.
AND a letter issued by the Home Office, to the holder, which indicates that the person
named in it has subsisting leave to enter or remain in the United Kingdom and is entitled
to take the employment in question in the United Kingdom.
Version 2
T A document issued by a previous employer, Inland Revenue, the Department for Work
and Pensions, Jobcentre Plus, the Employment Service, the Training and Employment
Agency (Northern Ireland) or the Northern Ireland Social Security Agency which contains
the National Insurance number of the person named in the document.
AND an Immigration Status Document issued by the Home Office, to the holder,
endorsed with a United Kingdom Residence Permit, which indicates that the holder has
been granted Limited Leave to Enter or Remain in the United Kingdom and is entitled to
take the employment in question in the United Kingdom.
U A work permit or other approval to take employment issued by Work Permits UK AND a
passport or other travel document endorsed to show that the holder has current leave to
enter or remain in the United Kingdom and is permitted to take the work permit
employment in question.
V A work permit or other approval to take employment issued by Work Permits UK AND a
letter issued by the Home Office to the holder, confirming the holder has current leave to
enter or remain in the United Kingdom and is permitted to take the work permit
employment in question.
Furthermore the exact date of expiry of the work permit / visa / etc must also be recorded
within out Adapt and payroll system (known as the flag up system) and once the relevant date
has been reached the temp can no longer be employed unless he / she produces a renewal