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SMP Reg Form
- 1. REGISTRATION FORM POSITION APPLIED FOR: PAST WORK EXPERIENCE: PERSONAL DETAILS: Title: Forename Surname: Address: Face Book: Linked In: Email: Postcode: Tel No: Mobile: Date of Birth: NI No: UTR: Nationality: Work Permit Required? Yes No Transport: Bus Train Underground Full UK License Any endorsements? yes No P.P.E: S/T Boots Hat Hi-Vi Gloves Goggles AVAILABILITY: Mon Tue Wed Thur Fri Sat Sun NEXT OF KIN: Name: Relationship: Tel. No.: QUALIFICATIONS & TRAINING DETAILS CSCS : Carded Applied for Card Passed Test Applied for test No CSCS Reg. No: _______________________ WORK HISTORY: Date Agency , Phone & Description of Rate Company Worked at Name Reported to Contact Number To - From contact Name Duties Paid on site & Email
- 2. DIVERSITY POLICY This company practices Equal Opportunity in employment and has a statement of Policy to that effect. The company is committed to monitoring the effectiveness of the policy in respect of job applicants and employees in accordance with the codes of Practice issued by the Commission for Racial Equality, the Equal Opportunities Commission and the Code of Practice relating to the Disability Discrimination Act. Information in this section will not be passed to third parties, other than in appropriate circumstances. Employees will have access to their recorded data CRIMINAL CONVICTIONS YES NO EQUAL OPPORTUNITY DETAILS YES NO Have you ever been convicted of a criminal Do you consider yourself to have a disability? offence? If yes Please give details (Under The Rehabilitation of Offenders If yes Please give details of the effects of the disability and of Act 1974, spent convictions need not be declared) any assistance you require to enable you to carry out the duties of the job HEALTH YES NO Do you have any medical illness? Are you on any medication? Do your fingers go white / numb when cold? CRIMINAL RECORDS BUREAU Do you suffer from tingling in the hands? Have you completed a CRB Check in the past? Y N Do you suffer from lack of grip in the hands? If yes, please specify: Enhanced Standard Do you have any pain in wrist or arm? Serial No: Issue Date: Do you feel that you have lost sensitivity in the fingers? HEALTH & SAFETY Have you noticed you now struggle with fiddly or fine tasks? Do you wear glasses or contact lenses? Have you been issued and understood Do you use drugs of abuse? SiteMasters Health & Safety Policy? Have you ever had any alcohol related illness? If you have answered yes to any of the above please give details: Are you in agreement to attend site inductions? Do you take responsibility to read any notices made available to you in respect of Heath & DECLARATION I understand that misrepresentation, falsification or omission of information requested on this application form may be cause for dismissal. Prior to any offer of work being made I understand that I shall provide documentary evidence of my eligibility to work in the U.K. I consent to the company recording my data and disclosing information contained on this form to third parties. I also consent to the company contacting my present and/or previous employer for a reference. Applicants Signature: Date: FOR OFFICE USE ONLY INTERVIEWERS NOTES Card Referral Prompt TSI Prompt Sell back CHECK LIST on file Expiry A B C Dt Passport / Birth Cert / ID card Personality Proof of eligibility to work in UK Availability UTR Appearance NI Ease of Travel CSCS (Letter or Card) References Interviewed by: Signed H & S Policy Signed Declaration Signature: Date