Title Page
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Employee Name
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Department
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Date Form Completed
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Date of Birth
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National Insurance Number
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Bank Account Details
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Account Number
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Sort Code
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Name on Bank Account
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Do you have documentation to prove you have the right to work in the UK?
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Documentation Shown
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Original Seen and Photograph is a True Likeness
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Documentation seen by
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Please take a photo of the ID
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Please provide us with next of kin details of who we would contact in the event of an incident
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Next of Kin name
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Next of kin contact number
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Relationship to next of kin
Medical Questionairre
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Have you ever had to give up a previous job for medical reasons?
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Please give details
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Have you been off work continuously for more than a month in the last five years?
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Please give details
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Do you regularly take tablets or medicine?
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Please tell us what and if it has any side effects that may impact your job
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Do you wear Glasses or have any Eye Sight Problems?
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Please give details
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Do you have any Hearing issues?
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Please give details
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Do you have any Physical or Mental Impairment that could be classed as a Disability under the Equality Act 2010?
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Please give details
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Are there any reasons why you should not do shift work?
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Please explain
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Are you able to carry out physical work such as lifting, climbing ladders etc?
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Please explain
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Has any previous occupation caused you any Health Problems?
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Please give details
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Do you suffer from any of the following:
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1 Epilepsy, fits, blackouts, fainting turns or unexplained loss of consciousness?
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2 Vertigo, dizziness, giddiness, problems with balance?
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3 Recurrent headache or migraine?
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4 Diseases of the nervous system e.g. neuritis, stroke, multiple sclerosis?
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5 Angina, heart disease or breathlessness?
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7 Raised or low blood pressure?
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9 Asthma, bronchitis, emphysema, pneumonia or any other lung disease?
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10 Jaundice or any form of hepatitis or other liver problem?
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14 Psoriasis, eczema, allergic skin rash or other skin disorder?
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16 Anxiety/depression, mental breakdown or stress related problems?
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20 Any operations or surgical procedures?
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21 Ear trouble or infected ear?
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24 Anxiety, depression or any other mental health condition?
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25 Peptic, gastric or duodenal ulcer?
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26 Any other serious illness not covered above?
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If you have answered yes to any of the above, please give further details to ensure the business can support you
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Please sign to confirm that all of the information in this form is accurate
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Name
Starter Checklist - For HMRC purposes
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The questions below are designed to help us ascertain what statement to put for you with HMRC. Please answer these truthfully, to ensure you are give the right tax code.
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Do you have a P45 that you can give us?
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Please confirm your sex as shown on your birth certificate or gender recognition certificate
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Do you have another job?
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You will be marked at Statement C - I have another job and/or I am in receipt of a state, workplace or private pension
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Do you receive payments from a state, workplace or private pension?
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You will be marked at Statement C - I have another job and/or I am in receipt of a state, workplace or private pension
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Since the 6th of April have you received payments from either another job which has ended or any of the following taxable benefits; jobseekers Allowance (JSA); employment and support allowance (ESA) or incapacity benefit?
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You will be marked as Statement A - This is my first job since the 6th of April and I have not received any benefits
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You will be marked as statement B - Since 6th Aril I have had another job but I don't have a P45 and I have not received any benefits
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Do you have a student or postgraduate loan?
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Do any of the following statements apply? You are still studying on a course that your student loan relates to; you completed or left your course after the start of the current tax year, which started on 6th April, you've already repaid your loan in full or you're paying the student loans company by Direct Debit from your bank to manage your end of loan repayments?
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Please sign to confirm the information you have given is accurate
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Do any of the following apply: you lived in Northern Ireland when you started your course or you lived in England or Wales and started your course before 1st September 2012?
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You are plan 1. Please sign to confirm the information given is accurate
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Did you lived in England or Wales and started your course on or after the 1st September 2012?
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You are Plan 2. Please sign to confirm the information given is accurate
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Have you lived in Scotland applied through the Students Award Agency Scotland (SAAS) when you started your course?
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You are plan 4. Please sign to confirm the information given is accurate
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Have you lived in England and started your postgraduate masters course on or after 1st August 2016 or lived in Wales and started your postgraduate masters course on or after 1st August 2017 or you lived in England or Wales and started your postgraduate doctoral course on or after 1st August 2018?
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You will be marked down as Postgraduate Loan (England and Wales only). Please sign to confirm the information given is accurate
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Please sign to confirm the information given in this form is accurate
Office Use / Additional Information - to be completed by HR
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Does this person require a Work Email address
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Please confirm one has been requested? (email rob@icgcards.com)
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Does this person require an allocated car parking space
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Please confirm one has been requested? (email accounts@icgcards.com)
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Does this person require setting up on the clocking in system?
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Please confirm this has been requested? (email george@icgcards.com)
