HRM 001 - New Starter Form - Element

• Site conducted

  Select

• Audit Title

• Conducted on

  Date

• Prepared by

Section A - Personal Information

Personal Details

• Start date

  Date

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• Photo of Operative

  Media

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• Proof of Address - Please take photo of POA in form of Utility Bill or Bank Statement dated in the last 3 months

  Media

• Contact number

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• Date of Birth (DD/MM/YYYY)

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• National Insurance Number (9 Digits eg. JN002244B)

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• Proof of NI - Please take photo of P45, P60, National Insurance Card or a letter from a government agency. (If National Insurance is temporary a copy of a letter from the DSS showing applicant has applied for valid NI must be available to photograph)

  Media

• A P45 or a completed HMRC Starter Checklist must be included on starter form. Please photograph and return original to office.

  Media

Emergency Contact Information

• Full Name (First and Surname)

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• Relationship

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  Select Parent Sibling Family Member Partner Friend Child

  • Parent
  • Sibling
  • Family Member
  • Partner
  • Friend
  • Child

• Contact Phone Number

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• Full Address and Postcode

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• Do you have any relatives currently working within the company?

  Yes

  No

• If ‘Yes’ Please give full name below.

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Bank Details

• Bank Name

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• Sort Code (6 Digits) eg. 11-22-33

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• Account Number (8 Digits) eg. 12312345

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• Or alternatively Building Society Roll Number if applicable

• Account Holder Name

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• Proof of Bank Details - Please photograph

  Media

• I confirm that the bank details provided above are correct and authorise payment of my wages into this account.

Identification

• Photo Of Passport

  Media

• Photo of Driving License (if Applicable)

  Media

• If neither of the above are available please provide Birth Certificate or Marriage Certificate as a form of ID

  Media

Right to Work

• Nationality

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• Do you require a ‘Right to Work’ ?

  Yes

  No

• If the answer is Yes please take photo of signed ‘Right to Work’ Checklist

• Add media

  Media

Health

• Do you have any allergies ?

  Yes

  No

• Do you have a heart condition ?

  Yes

  No

• Do you suffer from diabetes?

  Yes

  No

• Do you suffer from asthma ?

  Yes

  No

• Do you suffer from epilepsy ?

  Yes

  No

• Do you suffer from high or low blood pressure?

  Yes

  No

• Are you on any medication ?

  Yes

  No

• Do you have any other health problems or disability that could prevent you from carrying out your work safely?

  Yes

  No

• If you answer ‘YES’ to any of the above please give more information below

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Convictions

• Do you have any criminal convictions?

  Yes

  No

• If the answer is ‘Yes’ please list below

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References

• Please provide Name and Address of 2 References we can contact.

• Reference 1 - Full Name (First and Surname)

• Reference 1 - Full Address (Including Postcode) or Email Address

• Reference 2 - Full Name (First and Surname)

• Reference 2 - Full Address (Including Postcode) or Email Address

Part B - Medical / Educational Centres

• Is the operative going to be working at an Medical or Educational Centres?

  Yes

  No

• If the answer is 'Yes' Please complete all questions in this section so a DBS Basic Application Form can be completed. If the answer is 'No' please move on to Section C

• Please give any previous names you have been known by and dates changed that differ from full name given in Section A

• Please give the Town and Country you were born

• Please give your Mothers Maiden Name

• Please give your 5 years address history (Month and year moved)

• Please photograph 3 items of ID from the below list. One of which must be a valid passport, drivers license, P60 or P45: Current Passport Current Drivers License Birth / Marriage Certificate Bank / Credit Card Statement / Utility Bill - Dated within the last 3 months P60 / P45 / Mortgage Statement / Council Tax Letter - Dated within the last 12 months

  Media

• Please confirm you understand and agree that should you leave GCM Ltd within 12 Months of my start start date I will repay £38.33 application Fee for DBS

  Yes

  No

Hepatitis B Protection Element Cleaning ALWAYS carries out all necessary measures to protect its staff when on site carrying out their duties. With some sites there may be additional protection required, ie, Doctors surgeries, hospitals, treatments rooms that have additional risks to other sites. With the above site we advise all staff are protected by Hepatitis B injection, while this is a precautionary measure (many actions are already in place to prevent accidents) it would be careless of us not to advise our staff to have the added protection. If you are already protected please tick the box below. If you understand the risks, yet would like to decline the injection (it is not compulsory) please also tick the relevant box. If you are happy to have the injection please also tick in the relevant box. The cost of the injection will be deducted from your final salary payment if you leave or your position at Element is terminated. Current cost is £160.00

• I am already protected from Hepatitis B

• And I had my last injection on

• I understand the risks, but would like to decline the injection

• I am happy to have the Hep B injection, I understand Element Cleaning will make necessary arrangements for my protection

Confidentiality

• Please confirm the separate confidentiality has been completed and sent to Practice manager.

Section C - Employee Signature

• I have read and understood all of the above and confirm that all answers above have been given honestly.

  Sign

Managers Signature

• I confirm all sections above have been completed and all documentation has been checked by me at time of New Starter Meeting.

  Sign