Apply for Perm/Temp Registration Form

Personal Details

Full Name*

Title (Mr, Mrs, Miss, Master, Dr, etc.)

First Name

Middle Name

Last Name

Date of Birth

Date of Birth*

Nationality

National Insurance Number:*

Phone Number:*

Email address:*

Postal/Home Address*

Postcode:*

Emergency Contact:

First name

Last name

Emergency Contact Phone Number:*

Personal Bank Account Details

Account Holder Name:*

Bank/Building Society Name:*

Account Number:*

Account Sort Code:*

Branch Location:*

KCJ Care and Wellbeing will not be held liable if the incorrect bank details have been entered. By ticking this box, you confirm that the bank details provided are correct.*

Yes

Employment History & References (Part 1)

KCJ Care and Wellbeing require a minimum of two years employment history, or an understanding of any gaps in your employment during this period if necessary. We also require 2 referee contact details in order to carry out reference checks.

If you are currently employed, what notice are you required to give your employer?

Current/Previous Employer

Company Name

Your Job Title:

Length of Employment:

Reason for Leaving:

Company Address:

Company Postcode:

Company Phone Number

Reference Contact Name:

Reference Email Address*

Reference Direct Line:

Company Name

Position (Job Title)

Length of Employment

Reason for Leaving

Company Address:

Company Postcode

Company Phone Number:

Reference Contact Name:

Reference Email Address:

Reference Direct Line:

Employment History & References (Part 2)

If you have any gaps in work history within the last 2 years that has lasted longer than 6 weeks, please explain why this was in the box below.

In accordance with the Data Protection Act 1998 and with the General Data Protection Regulation 2018, by proceeding with this application, I give consent and authorise KCJ to contact the referees and organisations mentioned within my application for the purposes of obtaining current and previous employment reference information

Not Applicable

Criminal Record Disclosure & Additional Information

We are asking you to complete this section in relation to job roles which are not exempt from the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020). For this reason, you are only required to disclose information about unspent convictions. You are not required to disclose spent convictions on this form.

Additionally, you are not required to declare any information about ‘protected’ offences – (offences to which the filtering rules apply). If you are unsure as to whether a conviction is unspent/spent or protected (filtered), please contact organisations such as NARCO or Unlock for further information.

If you wish to be put forward for/if any role is identified which may be suitable for you but which is exempt from the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020), meaning that you are required to disclose spent convictions, we will ask you to complete an additional crime disclosure form. You are not required to complete that additional form if you do not wish to be put forward for that type of work.

Do you have any unspent criminal convictions?*

Yes

No

If you answered yes, there are two ways of providing further details. You can either provide the offence dates, dates of conviction/caution, offence types and sentences below.

Alternatively, you can provide further details (as above) on a separate document by ticking the box below. Please provide this information in a sealed envelope to KCJ’s Head Office. Please mark the envelope as ‘confidential’.

I'll provide this information in a sealed envelope to KCJ’s Head Office

Are you prepared to undergo a drug test and/or alcohol test should it be requested?*

Yes

No

Job Flexibility & Questions

Date of Completion:

Availability

Earliest start time

Mon start time

Tue start time

Wed start time

Thur start time

Fri start time

Sat start time

Sun start time

Latest start time

Mon finish time

Tue finish time

Wed finish time

Thur finish time

Fri finish time

Sat finish time

Sun finish time

Preferred weekly contract hours:

Available to start employment from:

Preferred shift pattern:

Weekend availability:

Form of transport to and from work:

Qualifications/Training:

Please provide details of any outstanding holidays to be taken:

Are there any further details you would like to provide us with:

Declarations (Part 1)

Working Time Regulations 1998 – Opt Out Agreement

1.RESTRICTION
The Working Time Regulations 1998 (as amended) provide that the Employee shall not work on an Assignment with the Client in excess of the Working Week unless s/he agrees in writing that this limit should not apply.

2.CONSENT
The Employee hereby agrees that the Working Week limit shall not apply to the Assignment.

3.WITHDRAWAL OF CONSENT
3.1 The Employee may end this Agreement by giving the Company 3 weeks’ notice in writing.
3.2 For the avoidance of doubt, any notice bringing this Agreement to an end shall not be construed as termination by the Employee of an Assignment with a Client.

3.3 Upon the expiry of the notice period set out in clause 4.1 the Working Week limit shall apply with immediate effect.

4.THE LAW
This Agreement is governed by the law of England & Wales and is subject to the exclusive jurisdiction of the Courts of England & Wales.

By ticking this box, you are agreeing to the working week limit not applying whilst on assignment with KCJ Care and Wellbeing LTD, as per the Working Time Regulations 1998 – Opt Out Agreement.

General Data Protection

KCJ Care and Wellbeing LTD provides a work finding service to its clients and work-seekers. We must process data (including sensitive personal data) so that we can provide these services. In doing so, we act as a data controller. The personal data that you have provided us throughout your registration form will be processed in accordance with data protection laws. We have provided you with a ‘Privacy Notice’ document which is also accessible via our website – www.kcjcare.co.uk which explains how we manage your personal data.

I understand that whilst on assignment(s) with KCJ Care and Wellbeing, the agency may process my personal data with third parties for the purposes of internal audits and investigations carried out on the Company to ensure that the Company is complying with all relevant laws and obligations.

The consent I give to the Company will last for the length of my assignment(s) and 6 years after termination of contract. I am aware that I have the right to withdraw my consent at anytime by informing KCJ Care and Wellbeing LTD in writing, that I wish to do so. However, I understand that the company may continue to process my personal data where it has a legal obligation to continue to do so.

Note: Data includes aspects such as Full Name, DOB, Mobile Number, Email Address, Postal/Home Address, CV, NIN, Disability/Health Condition relevant to the role, Criminal Record if relevant to the role etc.

By ticking this box, you are confirming that you have read and understand the ‘General Data Protection’ declaration alongside the ‘Privacy Notice’ and give consent.

Declarations (Part 2)

Manual Handling & Good Handling Techniques for Lifting

Where possible, I will always strive to follow the guidelines and protect my safety whilst on assignment(s) for KCJ Care and Wellbeing. I will always consult my direct Supervisor or KCJ Care and Wellbeing should I need clarification on any point regarding Manual Handling.

Have you received Manual Handling Training with previous employers?*

YES

NO

By ticking this box, you are confirming that you are happy to sign the ‘Manual Handling’ declaration and that you have read the ‘Good Handling Techniques for Lifting’ document.

Health and Safety

All employers have a Health and Safety Policy stating who is responsible for Health and Safety, and the arrangements that are put in place. It is your responsibility to familiarise yourself with this policy, particularly the procedures for fire, first aid and accidents upon arrival at the clients’ premises. All workers have a duty under the Health and Safety Act to take reasonable care to safeguard their own safety and the safety of others. The Act also requires workers not to interfere with or misuse anything provided to protect health, safety, or welfare in compliance with the act.

By ticking this box, you are confirming that you understand the above and are happy to sign the ‘Health and Safety’ declaration.

General Health

Do you have any health issues or a disability relevant to the role which may make it difficult for you to carry out functions which are essential for the role you seek?*

YES

NO

If you have a disability, what are your needs in terms of reasonable adjustments in order to access this recruitment service?

By ticking this box, you are confirming that you have completed the above to the best of your knowledge and understand that I must inform KCJ of any changes which may affect my ability to undertake assignments.

Declarations (Part 4)

KCJ Care and Wellbeing’s Declaration

KCJ Care and Wellbeing shall not discriminate unlawfully when deciding which candidate/temporary worker is submited for a vacancy or assignment, or in any terms of employment or terms of engagement for temporary workers. KCJ 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 vacancy. I confirm that the information I have provided is correct and can be verified by references from previous employers and/or professional bodies specified. Regarding references, I give my consent for referees and organisations mentioned within my application to be contacted for the purposes of reference information. I understand that my data may be held within a computerised database/platform which KCJ Care and Wellbeing deem necessary. I confirm that KCJ Care and Wellbeing have provided me with terms of engagement (contract of employment). I have read this through thoroughly, understanding and accepting these terms. You can view our policies on our website – www.kcjcare.co.uk. Whilst on assignment with KCJ Care and Wellbeing, I will ensure that my timesheet is signed and returned to Head Office by 11am the following Monday to allow our payroll team to uncover and resolve any discrepancies if there are any. I undertake to inform KCJ Care and Wellbeing of the outcome of all introductions and/or interviews to companies or agencies. I will regard all information as private and confidential, ensuring I do not divulge it to any third parties.

Please the box below to confirm that you agree to all the terms stated in this form and that the information provided is accurate to the best of your knowledge.

Name*

Date

Signed*

Date*

Please click on the submit button below to successfully submit your application.

UPLOAD A PICTURE OF YOUR PASSPORT FRONT COVER:

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UPLOAD A PICTURE OF THE INSIDE OF YOUR PASSPORT:

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UPLOAD A PICTURE OF THE FRONT OF YOUR DRIVING LICENCE:

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UPLOAD A PICTURE OF THE BACK OF YOUR DRIVING LICENCE:

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UPLOAD A PICTURE OF YOUR NATIONAL INSURANCE PROOF:

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UPLOAD ANY REQUIRED VISA PERMITS IF APPLICABLE:

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UPLOAD YOUR CV:

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Personal Details

Personal Bank Account Details

Employee Statement

Student Loans

Employment History & References (Part 1)

Current/Previous Employer

Employment History & References (Part 2)

Criminal Record Disclosure & Additional Information

Job Flexibility & Questions

Availability

Declarations (Part 1)

Working Time Regulations 1998 – Opt Out Agreement

General Data Protection

Declarations (Part 2)

Manual Handling & Good Handling Techniques for Lifting

Health and Safety

General Health

Declarations (Part 3)

Health Self-Assessment for Night Working Hours

If you indicated yes, are they based on:

Declarations (Part 4)

KCJ Care and Wellbeing’s Declaration