Candidate Registration Form

Name *

Title *

Previous Names

Address *

Address Line 1

City

State / Province / Region

Postal Code

National Insurance Number *

Date of Birth *

Phone *

Email *

Emergency Contact

Next of Kin or Emergency Contact

Relationship to you

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Work Eligibility

Are you eligible to work in the UK? *

Type of Visa / Work Permit

Visa Expiry Date

Qualifications

Qualification *

Date obtained *

University

Degree Subject

Employment History

Name of Employer

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Dates From

Job Title

Salary/Rate Per Day

Reason for Leaving

Would you like to add an additional employer?

Name of Employer

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Dates From

Job Title

Salary/Rate Per Day

Reason for Leaving

Would you like to add an additional employer?

Name of Employer

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Dates From

Job Title

Salary / Rate Per Day

Reason for Leaving

References

Referee 1

Name

Position

Company

Phone

Referee 2

Name

Position

Company

Phone

Type of Work

What type of work are you looking for? *

Short Term
Long Term
Permanent

Required Rate / Salary *

Type of Work

Criminal Record & Security Checks (where applicable)

A criminal record check from the Disclosure and Barring Service may be required.

Do you hold a Disclosure and Barring Service check or overseas police check within the last 3 years? *

Have you ever been convicted of a criminal offence which is not spent under the Rehabilitation of Offenders Act 1974? *

Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) *

If yes, please give details:

UK Residence

Please state any periods of residence outside your country of origin within the last 5 years and any periods of more than 12 months at any time.

Interview and Assessment

Are there any adjustments that need to be made for you to attend an interview or undertake an assessment as part of an interview process? *

Bank Details

PLEASE CHECK CAREFULLY TO MAKE SURE YOU GET PAID CORRECTLY

Name Account Held In

Bank Name

Bank Address

Account Number

Sort Code

Declaration

Confirmation *

I confirm that the information provided on this form and within my CV, if applicable, is both truthful and accurate. I have omitted no facts that could affect my future employment. I understand that any engagement entered into is subject to documentary evidence of my right to work in the UK, verification of any professional qualifications and, in the case of temporary assignments, subject to satisfactory references. I expressly consent to any sensitive or personal data, disclosed as part of my application, being used in connection with the search for work, subject to the relevant Data Protection legislation. I will inform GPN Recruitment immediately of any circumstances that may affect my work, such as changes to health, subsequent pending prosecutions or convictions, which may arise whilst I am registered for permanent or temporary work.

Signature

Clear Signature

Name *

Date