New Starter Information Form

1. Personal Details

First Name *

Surname *

Address *

Postcode *

Phone Number *

Email Address *

Date of Birth *

National Insurance Number *

Marital Status *

Gender *

2. Right to Work

Nationality *

Passport Number

If other than British, provide Share Code / Visa document details

Right to Work Evidence *

British: attach passport evidence. Other nationality: attach Share Code, Visa or other Right-to-Work evidence. Multiple pictures/files allowed.

3. Employee Details

Start Date *

Job Title *

Previous Employment *

Valid Licence? *

Training Certificates

Other Certificates

4. Payroll Information

Bank Name *

Account Name *

Account Number *

Sort Code *

Do you have a P45? *

P46 Starter Form

Personal details are taken from Section 1 and are not requested again here.

Employee Statement

You need to select only one of the following statements A, B or C *

This is my first job since 6 April and I've not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension. This is now my only job but since 6 April I've had another job, or received taxable Jobseeker's Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a State or Occupational Pension. As well as my new job, I have another job or receive a State or Occupational Pension.

Student Loan Questions

9. Do you have one of the Student Loan Plans described below which is not fully repaid?

Yes No

Postgraduate Loan

You'll have a Postgraduate Loan if:
• you lived in England and started your Postgraduate Master's course on or after 1 August 2016
• you lived in Wales and started your Postgraduate Master's course on or after 1 August 2017
• you lived in England or Wales and started your Postgraduate Doctoral course on or after 1 August 2018

13. Do you have a Postgraduate Loan which is not fully repaid?

Yes No

P46 Declaration

I confirm that the information I've given is correct.

5. Next of Kin Personal Details

Name *

Relationship *

Address *

Postcode *

Phone *

Email *

Health Questionnaire

Lead/Zinc at Work

Asbestos at Work

Other relevant

Question	Yes / No	Details / Evidence
An epileptic seizure or fit?	Yes No
Any medication, substance or alcohol related dependency?	Yes No
Sudden attacks of disabling giddiness, fainting or blackouts?	Yes No
Circulatory or heart problems such as high blood pressure, etc.?	Yes No
A major or minor stroke?	Yes No
A shortness of breath or chest tightening (angina) when doing exercise?	Yes No
Diabetes?	Yes No
Any eyesight defects?	Yes No
Any serious illness or accident?	Yes No	Optional photo/evidence if Yes
Asthma, Tuberculosis or any other chronic lung Disease?	Yes No
Persistent coughing?	Yes No
Dermatitis, eczema or any other skin complaint?	Yes No	Optional photo/evidence if Yes
Allergies or sensitivity to any antibiotics or other substances/materials? (i.e. penicillin)?	Yes No
Tinnitus-ringing in the ears?	Yes No
Difficulty in hearing instructions?	Yes No
Tingling or numbness in the fingers?	Yes No
Difficulty in maintaining a grip or doing fine work?	Yes No
Blanching of the fingers (white finger)?	Yes No	Optional photo/evidence if Yes
Pain in fingers, especially when cold	Yes No
Pain, aching or discomfort in the back, shoulders or neck?	Yes No
Numbness, tingling or swelling of joints and muscles?	Yes No	Optional photo/evidence if Yes
Increased emotional reactions; more sensitive or aggressive?	Yes No
Have difficulty in concentrating or poor memory?	Yes No
Increased difficulty in sleeping?	Yes No
An occupational disease - or have you been rejected from employment on medical grounds?	Yes No
Have you seen a doctor in the past 3 years?	Yes No
Are you currently on any medication not related to the illnesses mentioned above?	Yes No
Are there any other conditions which you feel may affect your ability to do your work?	Yes No
May our Company Appointed Doctor or Fit for Work contact your GP in respect of any health issues?	Yes No

Additional Details

Name of Doctor

Doctor Phone

Medical Centre Address

I confirm that the information I've given is correct.

Personal Protective Equipment

Item	Yes / No	Comments
Safety boots	Yes No
Hi visibility vest	Yes No
Hi visibility jacket	Yes No
Fleece jacket	Yes No
Gloves	Yes No
Safety glasses	Yes No
Safety helmet	Yes No
Safety harness	Yes No
RPE	Yes No
Additional PPE item 10	Yes No
Additional PPE item 11	Yes No
Additional PPE item 12	Yes No

Rehabilitation of Offenders Questions

Do you have any unspent conditional cautions under the Rehabilitation of Offenders Act 1974?

Yes No

Do you have any adult cautions (simple or conditional) or spent convictions that are not protected under the applicable Exceptions Order?

Yes No

Policies, Agreements & Acknowledgements

I have read and understood the Data Protection / Privacy information.

I have read and understood the Integrated Management System information.

I agree to the 48-Hour Opt Out Letter.

I have read and agree to the Driving Policy.

I have read and agree to the Alcohol & Drug Policy.

I have read and agree to the Training Agreement.

I confirm that the information I've given in this form is correct.

Final Signature

This single signature applies to the completed New Starter form, declarations, acknowledgements and policies above.

Sign this form *

Sign above using your mouse, touchscreen or finger.

New Starters Information Form

1. Personal Details

2. Right to Work

3. Employee Details

4. Payroll Information

P46 Starter Form

Employee Statement

Student Loan Questions

Postgraduate Loan

P46 Declaration

5. Next of Kin Personal Details

Health Questionnaire

Personal Protective Equipment

Rehabilitation of Offenders Questions

Policies, Agreements & Acknowledgements

Final Signature

Data Protection / Privacy

Integrated Management System (IMS)

48-Hour Opt Out

Driving Policy

Alcohol & Drug Policy

Training Agreement