Deluxe Staffing - Application Form

Right to Work
Nationality*
Passport Expiry Date*

DayMonthYear
Date
Upload Passport Copy*

Cancelof
- Does your right to work document has expiry date?*
- Visa Expiry Date*
  
  DayMonthYear
  Date
- I can provide online verification code from government websiteI have original documents and I can attach a copy (e.g. VISA, residence card or permit)
- Please click on the link below to goverment website to obtain proof of work online code and then return here and insert the code into the next field.
  
  (you will be re-directed to another tab on your browser. Once you have the code, select to this tab to continue the application).
  
  www.gov.uk/prove-right-to-work
- Right to work code obtained from the above link*
- Are you a Student **
- Upload Visa Copy*
  
  Cancelof
- Are you a Student*
- Immigration VISA Type*
- Academic term and vacation times letter from your College*
  
  Cancelof

- Home Address
- House Number*
- Street Name*
- Address line 2 (if required)
- Town*
- County*
- Post Code*
- Proof of Address (Not older than 3 months; bank statement, utility bill, letter addressed to you)
  
  Cancelof

Next of kin (emergency contact)
Next of kin - Name
Next of kin - Contact Number
Relationship

Bank Account Details
Bank*
Sort Code*
Sort Code (enter again)*
sort code calculation
The Sort Code entered do not match on both fields, please double check and enter again.
Account Number*
Account Number (enter again)*
account calculation
The account number entered do not match on both fields, please double check and enter again.

- OPT OUT OF 48 HOUR WORKING WEEK AGREEMENT
  
  The Working Time Regulations 1998 provide that an Employee shall not work in excess of the Working Week unless he/she agrees in writing that this limit should not apply.
  
  I agree that for the purpose of the Working Time Regulations 1998 (and any amendment or re‐enactment thereof) any legislative provisions imposing a maximum number of average weekly working hours shall not apply to my employment. However, I may revoke my agreement to this at any time by giving Deluxe Staffing Limited not less than three months written notice of my intention to do so. By not ticking this box you are not agreeing to exceed the 48 hours working week period.
- I Agree
- I understand that Employment Particulars book will be shared with me via email immediately after completing this registration
- DATA PROTECTION
- I give my permission for the company to store and use my sensitive personal data, in relation to my application for employment. I understand that this term covers information relating to my ethnic origin, trade union membership, criminal or alleged offences, and my physical and mental health. I also understand that this is not an exhaustive list. I also give my permission to share this information with third parties.
- I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients. I consent to references being passed onto potential employers.If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Deluxe Staffing 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).

National Insurance Number
P46 tax form
Employee statement (P46)

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

A ‐ This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State Pension or Occupational Pension.

B ‐ This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker's Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a State Pension or Occupational Pension.

C ‐ As well as my new job. I have another job or receive a State Pension or Occupational

--------------------------------------------------------------------------------------------

D ‐ Do you have a Student Loan which is not fully repaid and all of the following apply?
- You left a course of UK higher education before last 6 April.
- You received your first Student Loan instalment on or after 1 September 1998.
- Select 'No' if you are repaying your Student Loan direct to the
- Student Loans Company by agreed monthly payments.
ABC
YesNo

Health questionnaire for night workers
The purpose of this questionnaire is to ensure that you are suited to work at night. All information provided will be held as confidential.

If you have answered, “yes” to any of the below questions you may be asked to see a nurse or doctor for a further assessment.
Heart or circulatory diseasesStomach or intestinal disordersAny condition which causes difficulty sleepingChronic chest disorders (especially if night time symptoms are troublesome)Any medical condition which requires medication to a strict time tableOther health issues which may affect your fitness at nightNone of the above

Form of Authority
I authorise Deluxe Staffing Ltd to approach the individuals and organisations listed below for verification of my education, employment and unemployment record and to obtain any other information which may be pertinent to my application for employment with Deluxe Staffing Ltd.

I further authorise Deluxe Staffing Ltd to transfer its finding together with any other information obtained to our customer and understand that it will only be used for the purposes of this application for employment.
- Personal referees
- Character referees
- Employers
- Professional advisors
- Educational establishments
- The Department for Work and Pensions/Job Centres
- The Inland Revenue
- The Criminal Records Bureau
- Disclosure Scotland
- Professional bodies
- Credit referencing agencies
- Companies House
By ticking this box I also authorise Deluxe Staffing Ltd. to approach my current employer for verification of my most recent employment.
Agree

Data protection

Information from this application may be processed for purposes registered by the Employer under the Data Protection Act 1998. Individuals have, on written request [on payment of a fee] the right of access to personal data held about them.
I hereby give my consent to Deluxe Staffing Ltd processing the data supplied in this application form for the purpose of recruitment and selection.
Temporary worker contract for services. You can read full contract via the link below.

Temporary worker contract for services.pdf
Signature*

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SENTENCE	PERIOD BEFORE OFFENCE IS SPENT
A sentence of imprisonment or youth custody for more than 6 months but not more than 30 months	10 years
Imprisonment not exceeding 6 months	7 years
A fine or other sentence not expressly covered by the Act	5 years

Rows	Date	Offence	Sentence

Application Form

Personal Details

Right to Work

Home Address

Next of kin (emergency contact)

Bank Account Details

DATA PROTECTION

P46 tax form

MEDICAL QUESTIONNAIRE

Health questionnaire for night workers

Form of Authority

PERSONAL DECLARATION - CRIMINAL CONVICTIONS

CRIMINAL RECORD