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Employee Registration Form

NAME:

Employee No:

DOR:

Please complete this registration form in black ink or typed face and then return to the

AAA Recruitment Solutions Ltd (email address: lcaaarecruitmentsolutions@gmail.com)

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35 Manchester Road, Preston PR1 3YH

Web: www.aaahealthcare.co.uk E-mail: lcaaarecruitmentsolutions@gmail.com

Telephone: 01772 386299 Mobile: +44 074 78995777 +44 07399579a282

AAA RECRUITMENT SOLUTIONS LTD

Registration Form

Thank you for registering with AAA Recruitment Solutions Ltd. To complete your registration please work

through this registration pack to the best of your ability. If you have any questions or queries, please do not

hesitate to use the contact details on the front page and we will help in any way we can.

We will also require the following documents prior to you starting work with AAA Recruitment Solutions

Ltd:

Completed registration pack Proof of right to work in the UK Proof of identity-if not same as above 2 proofs of Address/Bank letter Proof of your National Insurance Number Reference details for the last 5 years All relevant details, certificates and qualifications Vaccination certificate Enhanced DBS check/DBS details 2 passport photos A copy of your up to date CV P45/P46

Please note that it is a legal requirement to have a valid enhanced DBS (Criminal Record Check).

AAA Recruitment Solutions Ltd will not place you into employment without this check. We can and will conduct this on your behalf; however, there is a cost of £52.40 which will be required to be paid by yourself upon registration. However, if you have already carried out a DBS check with another organisation and are subscribed to DBS checking service you must provide a DBS registration number to us. For more information about DBS checking service, please visit https://gov.uk/disclosure-and-barring-service-criminal-record-checks-referrals-and-complaints

Please also provide us with a fitness to work certificate.

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Registration

Personal Details

Title (Mr, Mrs, Ms, Miss)

First Name(s)

Surname

Address

Postcode

Nationality

Contact number

Email

Date of birth

National Insurance Number

What kind of work are you

looking for?

Please attach CV (if applicable) or Email to lcaaarecruitmentsolutions@gmail.com

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Employment History

From - To Job Title Employer’s details Reasons for leaving

From – To

Job Title Employer’s details Reasons for leaving

From – To

Job Title Employer’s details Reasons for leaving

Education

Year University/College/School Qualifications

Please use an additional sheet if necessary.

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References

Name

Relation

Address

Email

Telephone

Name

Relation

Address

Email

Telephone

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Next of Kin

Name

Address

Postcode

Contact Number

Bank Details

Bank name

Bank address

Name of Account Holder

Sort code

Account Number

(N.B. If you feel uncomfortable giving us the data above at this point, we are happy to take it at any

point prior to commencement of work)

Health Information

(Please fill in the following form with your current GP’s details)

Doctor’s name

Practice name

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Address

Postcode

Telephone number

Please read carefully and answer every question to the best of your knowledge. If you answer YES, you

must provide further details. Failure to do so will result in a delay in processing your assessment.

Yes No

1) Have you ever had a health condition that may have been caused by work?

2) Do you have any health condition that you think may affect your performance

or safety at work?

3) Do you have any problems with hearing?

4) Do you have any problems with your eyesight (not corrected with

spectacles/contact lenses)?

5) Have you had any skin problems e.g. eczema, psoriasis, recurrent skin

infections, allergic rashes?

6) Have you ever experienced a fit, blackout or unconsciousness?

7) Have you ever had any mental health problems (e.g. anxiety, depression,

nervous breakdown, stress, self-harm, eating disorders and addictions)?

8) Have you ever been admitted to hospital?

9) Are you taking any medication (excluding contraception), or are you under any

form of treatment at the moment?

10) Do you have any health conditions that cause difficulty with;

Sitting

Standing

Moving around

Bending, lifting or carrying

Working with a computer

11) Are you waiting for any investigations, treatment or admission to hospital?

12) Have you consulted a doctor/GP/specialist in the last year?

13) Have you been absent from work/study due to illness in the last two years?

If YES give details of the number of occasions, the reason and the duration of

each absence below.

14) Do you have any disability or health condition not already mentioned for which

you think you may require support or adjustments to do your job?

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Patient safety code

For all staff involved in care of patients.

If you are HIV positive, or suspect that you maybe, and you will be involved in the care of patients,

you must declare this in confidence to staff at AAA Recruitment Solutions Ltd. If aspects of your work

may involve a risk of transmission to patients, you must not carry out such work until the risk has been

assessed any necessary measures to prevent transmission agreed and implemented.

During your employment you must inform the agency, if at any time:

You are diagnosed as HIV positive or suspect that you may have been infected with the virus.

you contract any other infection which could be transmitted to and endanger patients.

If your work involves you undertaking or assisting with surgical or exposure prone procedures, you

cannot be passed fit for work until we have obtained satisfactory documented evidence of your

hepatitis B status or other tests necessary to comply with our Control of Infection policies. You must

also inform us if you have ever been tested positive for any transmissible blood borne virus infection

such as Hepatitis B, Hepatitis C or HIV.

I have read the above and agree to comply with the agency’s Patient Safety Code

Signed………………………… Date……………………..

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Night Workers Declaration

This declaration is to excess if you have any health conditions that may affect your ability to person

night work.

This assessment is now a requirement of the Working Time Regulations Act 1988.

Do you have any health factors that may affect your fitness to do your night work?

Yes:

No:

If yes, please explain below.

DECLARATION:

I declare that the foregoing statements are true and complete to the best of my knowledge

Signed: ……………………………………… Date: ……………………………

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Criminal Conviction form If your application is successful and you take up employment with us, it is possible that you will be asked to

verify the information given here by obtaining a Criminal Records Bureau Disclosure.

Name:

Are you registered with any professional bodies: Yes: No:

If yes, please state:

Have you been subject to any kind of investigation/suspension by either an NHS body, or other wider public sector body, or

their relevant professional and regulatory body?

Yes: No:

If yes, please give further details:

Are you subject to any kind of investigation or prosecution

relating to a conviction, or which could lead to a conviction

since your most recent criminal record check was undertaken?

Yes: No:

If yes, please give further details:

Do you have any unspent/spent criminal convictions? Yes: No:

Offence Details Sentence Date of sentence

This information given by me in this form is to the best of my knowledge and belief, and it is true and

correct. I also understand that any misrepresentation by me will lead to the withdrawal of any offer of

employment, or my employment being terminated without any obligation of liability on the part of the

employer other than for services rendered.

I also confirm that if I become subject to an investigation by my professional body or a matter in

which could lead to a conviction, I will let the agency know straight away.

Signature:

Date:

*Certain types of employment and professions are exempt from the Rehabilitation of Offenders act 1974, and in those cases

particularly where the employment is sought in relation to positions involving working with children or vulnerable adults, details for

all criminal convictions must be given. The information given will be treated in the strictest of confidence and only taken into

account where, in the reasonable opinion of AAA Recruitment Solutions Ltd, the offence is relevant to the post to which you are

applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment I the

offence is not declared but later comes to light.

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CRB Form In order to work for AAA Recruitment Solutions Ltd, you are required to carry out a CRB check with us.

The cost of this is £52.40.

Please provide the following information in order to complete your CRB check:

Previous addresses for the last 5 years: Dates from and to:

Previous Names: Dates from and to:

I give consent for AAA Recruitment Solutions Ltd to complete a CRB check along with my

application documents.

Signature:

Print Name:

Date:

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Confidentially Agreement

I ……………………………………………...confirm that during every assignment and afterwards I

understand the importance of:

Holding information relating to the client in the strictest confident, ensure it is kept safely and securely

when not in use. I acknowledge they no information is to be removed from the client’s premises

without the permission of the Client.

Using such information on for the purpose of the work for which it was given.

You must under no circumstances disclose any entry codes, security procedures, keep or make copies

of any keys fir any placement to any third parties without the express permission of the place of work,

and AAA Recruitment Solutions Ltd.

Under no circumstances must you use foul language, disruptive behaviour, use mobile phones during

contracted hours, or sleep during contracted work hours, even during breaks.

Please remember all candidates much act professional at all times, and respect the wishes of the staff

and clients.

Not disclosing to any third party or copy the information except as is required in the course of my

duties.

Any breach, either by me or third party, may result in legal proceedings being brought by the Client

against me to recover any losses that occurred as a result of a breach.

Signature:

Print Name:

Name:

Health Declaration

I can confirm that if I do become injured, diagnosed with any medical conditions or become pregnant I will

let the agency know straight away so they can undertake necessary provisions and ensure that I am not

exposed to any work conditions which could cause risk.

Signed:

Dated:

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Permission to work in the UK

Do you have immigration permission to work in the UK? Yes: No:

In line with UKBA guidance on the prevention of illegal working we will need to verify and take a copy of

your original ID documentation as evidence of your right to work in the UK if you are to be engaged by AAA

Recruitment Solutions Ltd for temporary work.

48 Hour Opt Our Agreement

I… agree that I may work for more than an average of 48hours a week. If I change my mind, I will give my

employer …………… (Months) notice in writing to end this agreement.

Signature:

Print Name:

Dated:

Audit Consent

If you are successful in your application, your documents may be required for auditing purposes.

I ………….. …………….confirm that I give permission for my file to be audited by a third party company.

Signature:

Print Name:

You are signing this form as confirmation that you have read and fully understood our Code of Conduct. By

signing this you are taking full responsibility for yourself in regards to any breach of this contract. If a breach

of contract has been made you will be subject to a disciplinary hearing so, please make sure you have fully

understood the document.

Signature:

Print Name:

Date:

Incomplete forms may be returned and may delay in offering you agency work.

ALL SUCCESSFUL CANDIDATES SHOULD COMPLETE THE DECLARATION BELOW.

Declaration I hereby confirm that the information given is true and correct. I have read and understood all

statements.

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If, during the course of a temporary assignment, the Client wishes to employ me direct, I

acknowledge that AAA Recruitment Solutions Ltd 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).

Signature:

Print Name:

Date:

AVAILABILITIES:

Please tick what days you are available,

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

Signature:

Print Name:

Date:

35 Manchester Road, Preston PR1 3YH

Web: www.aaarecruitmentsolution.co.uk E-mail: lcaaarecruitmentsolutions@gmail.com

Telephone: 01772 386299 Mobile: +44 074 78995777 +44 07949077669