Umbrella Employed Application Before filling out this form, please read our specialised services contract here About You Title Name Date of Birth Date of Birth Sex Sex Male Female Phone Number Email Mobile Number Nationality Please note it is your responsibility to inform us of any change in job title or description Job Title Please note it is your responsibility to inform us of any change in job title or description National Insurance Number If you are a NON-UK National, in addition to the usual documentation we require a SHARE CODE available at this link S H A R E Code If you are a UK National, we require Passport, Proof of National Insurance (last payslip/P45/P60 etc) and Proof of address. Documents File InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, gif, png, mka. Max. file size: 16 MB If your files sizes exceed the 16MB limit, please use WeTransfer.com to send your documents to payroll@swiftpayrolls.ltd Professional Qualifications Held Qualification Documents Attach your certificates hereFile InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, gif, png, mka, 7z, xla, xls, xlt, xlw, mdb. Max. file size: 16 MB If your files sizes exceed the 16MB limit, please use WeTransfer.com to send your documents to payroll@swiftpayrolls.ltd Permanent Address Street Town Postcode Mailing Address Street Town Postcode Payment Details Please check the details above before submitting your application as All Sourcing cannot be held responsible for monies released to incorrect bank details. Name of Bank/Building Society Branch Location Name of Account Holder Sort Code Account Number Roll Number Agency Details Agency Name About the Assignment Is the Assignment Is the Assignment UK Based Abroad Offshore How would you classify the assignment How would you classify the assignment Trade Technical Professional Rail Clerical Medical Medical Classification Medical Classification General Medical Council (GMC)* General Dental Council (GDC)* Health and Care Professions Council (HCPC)* Nursing and Midwifery Council (NMC)* Please complete the following section if contracting within the medical sector only. GMC PIN GMC PIN GDC PIN GDC PIN HCPC PIN HCPC PIN NMC PIN NMC PIN Security Information To ensure that your financial and personal details are only discussed with yourself, we require security information. We will request this each time you contact us. Name of last school attended Mother’s maiden name Town of Birth How did you hear about us? How did you hear about us? Agency Workmate/Colleague Previous User Online Communication Next of Kin Details To ensure that your financial and personal details are only discussed with yourself, we require security information. We will request this each time you contact us. Next of Kin Name Next of Kin Home Number Next of Kin Contact Permission Next of Kin Contact Permission Please tick this box if you would like to nominate your next of kin to be able to speak on your behalf at times regarding personal information such as your payments. Yes No Next of Kin Mobile Number We offer a holiday pay system which is Contractor Retained, this is paid out weekly to you. Have you ever been convicted of a criminal offence? Have you ever been convicted of a criminal offence? Yes No Criminal Convictions Under the rehabilitation of offenders act 1974 you are required to give details of any convictions which are not ‘spent’. Failure to do so may render you liable to summary dismissal should you be appointed. Criminal Conviction Details Please detail criminal convictions Health and Safety The Health and Safety handbook details our policies and procedures for Umbrella employees. Health and Safety Handbook Agreement Health and Safety Handbook Agreement “I acknowledge I have read and understand the contents of the Health and Safety handbook and agree to comply with the policies and procedures contained within it”. Yes No Contract for Employment Please read the contract for employment. Complete and sign both copies and return one copy with your registration. Data Protection All data we hold about you and how we process and use it complies with the data protection act.From time to time, we may offer services or products which we feel may benefit you through carefully selected third partiese.g. accountancy services or mortgage advice. Employee Statement Please select just one of the following statements A, B or C. Employee Statement Option Employee Statement Option 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 or Occupational Pension. B - This in now my only job but since last 6 April I have had another job, or received taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive a State or Occupational Pension. C - As well as my new job, I have another job or receive a State or Occupational Pension. Student Loan Statement Student Loan Statement I have a Student Loan which is not fully repaid and I left a course of UK higher education before last 6 April and I received my first Student Loan installment 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. Yes No Previous Employment The Agency Worker Regulations ensure equal treatment for temporary workers in relation to an employee of the client doing the same job.As these entitlements start at week 12 we need to know prior working history if you have worked for the client in previous 18 weeks.Note we only need details below if you are starting your assignment with Swift Payrolls with a client that you have worked on assignment with in the last 18 weeks, this could be via a recruitment agency or another Umbrella Company. NB: DO NOT PROVIDE DETAILS IF YOU WERE WORKING FOR THE CLIENT ON A SELF-EMPLOYED BASIS. Please note failure to return this form will result in your payment being delayed. I have not worked for the client that I am currently starting an assignment with in the last 18 weeks I have not worked for the client that I am currently starting an assignment with in the last 18 weeks Yes No You are providing the information above based on the current assignment with Swift Payrolls. It is your responsibility to contact us and provide up to date Previous Employment History if you start another assignment with All Sourcing for a client that you have engaged with in the prior 18 weeks. By completing and signing this form you acknowledge that the responses you have provided above give a true and accurate reflection of your previous employment history. Declaration “I declare that the information I have provided is correct and I understand that it is my responsibility to inform Swift Payrolls of any changes to my job title, personal, bank or agency details as soon as possible. Providing incorrect or false information on this application form may result in the company invoking disciplinary procedures that may end in dismissal. I also confirm that it is my intention to undertake multiple assignments and will inform Swift Payrolls should my intentions change.I also agree to the terms and conditions set in the contract of employment”. I Agree I Agree Yes No Signature Please sign and save your signature SaveClear Submit
