Corrie Recruitment Limited

Application Form

Personal Details

Surname: / First Names: / Mr/Mrs/Ms/Miss:
Address: / Tel No:
Mobile No:
Postcode: / NI No:
Careers advice received if under 18 / Yes / No
Valid driving license / Yes / No
Own transport / Yes / No
Email:
Nationality: / DOB:
In line with UKBA guidance in 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 Corrie Recruitment Limited for temporary work.
Do you have immigration permission to work in the UK: / Yes / No / PORTW Provided: / Passport / P45 / P60 / N.I Card / Other
Work permit required: / Yes / No / Salary / Minimum rate of pay required:

Next of Kin

Name:
Address:
Contact Number:
Relationship:

Equal opportunities statement

Corrie Recruitment is committed to a policy of equal opportunities for all work seekers and shall adhere to such a policy at all times and will review on an on-going basis in all aspects of recruitment to avoid unlawful or undesirable discrimination. We will treat everyone equally irrespective of sex, 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.

Corrie Recruitment shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment, or in any terms of employment for temporary workers. Corrie Recruitment will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualification and ability to perform the relevant duties required by the particularly vacancy.

Professional References

Name: / Name:
Address: / Address:
Tel: / Tel:
Email: / Email:

Certificates (copies to be held on file)

Issued by: / Expiry date:

Employment Details (Present or last employer first – please cover 3 years where possible)

Date from: / To: / Company Name:
Company address: / Tel No:
Job Title: / Salary/pay rate: / Name of supervisor:
Job duties:
Reason for leaving:
Work via agency: / Yes / No / Agency name: / Tel No:
Date from: / To: / Company Name:
Company address: / Tel No:
Job Title: / Salary/pay rate: / Name of supervisor:
Job duties:
Reason for leaving:
Work via agency: / Yes / No / Agency name: / Tel No:
Date from: / To: / Company Name:
Company address: / Tel No:
Job Title: / Salary/pay rate: / Name of supervisor:
Job duties:
Reason for leaving:
Work via agency: / Yes / No / Agency name: / Tel No:

Education

Name of School: / Examination, subject and grades: / Date passed:
Further Education (Please include name of university/college & results of all examinations)
Job related/vocational additional courses/qualifications:

Personal Health Declaration

In the last 2 years have you been off work because of illness or injury? / Yes / No / If yes, give no. of working days lost
Have you now made a full recovery from your illness or injury? (if no, a doctor’s certificate is required stating that you are safe to return to work) / Yes / No
Are you at present having any treatment or medicine prescribed by a doctor? / Yes / No
Have you, or to your knowledge, any physical, mental or other condition that we should take into consideration when offering work? (If yes please give detail) / Yes / No

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 a disability relevant which may make it difficult for you to carry out functions which are essential for the role you seek? / Yes / No
If yes, please specify:
If you have a disability, what are your needs in terms of reasonable adjustments in order to access this recruitment service and to attend interview, or to take aptitude tests etc?

Data Protection

I will not at any time divulge to any person, nor use for my own or any other person’s benefit, any confidential information in relation to the Client or the Company or in relation to any of their employees, business affairs, transactions or finances which I may acquire during the terms of my assignment with the Company.

48 hour limitation waiver

The Working Time Regulations 1998 (“the Regulations”) require the Company to limit your average weekly working time to 48 hours unless you agree with the Company that limit shall apply to you.

The Company wishes to have an agreement with you. It proposes an agreement (which will apply until terminated by notice) on the basis that:

  1. The 48 hour limit on average weekly working time will not apply to you;
  1. You may terminate the agreement (so that the 48 hour time limit would apply to you) by giving the person at the Company to whom you usually report 4 weeks’ written notice.

Under the Regulations, the company must keep records relating to your working time. This is the case whether or not you reach an agreement with the Company about waiving working time limits.

If you accept the Company’s proposal, please sign below. This document will then be the record of the agreement between you and the Company.

Signature: / Print Name: / Date:

Rehabilitation of Offenders Act 1974 declaration

Do you have any *unspent criminal convictions? / Yes / No

If you answered yes to the above, supply the following details:

Date / Details of Offence / Sentence

* 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 Corrie Recruitment Limited, 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.

Personal Declaration

I confirm the information given on my application is correct and there is nothing further, about which I am aware, that should be taken into account when offering me work. I understand that, should any information prove inaccurate, my assignment may be terminated.

I hereby authorise Corrie Recruitment to seek references and I understand the information may be used to assist with my application for work and be passed to potential employers. I agree that information given on my application may be used for registration purposes under the Data Protection Act. I also agree that should ‘Stop and Search’ be used on Corrie Recruitment or Client’s premises, I shall comply with instructions. I confirm the terms of the declaration, and agree to be bound by them.

If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Corrie Recruitment Limited will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client).

Signature: / Print Name: / Date: