PFML New Starter Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Personal Details

• First Name

• Surname

• Address

• Date of Birth

• National Insurance Number

• Landline

• Mobile

• Email Address

• Ethnic Origin

• Nationality

• Criminal Convictions

  Yes

  No

  N/A

Next of Kin

• Next of Kin Name

• Next of Kin Contact

Site Details

• Site Name

• Rate of Pay

• Hours per shift

• Days Worked

  Select Monday Tuesday wednesday Thursday Friday saturday Sunday

  • Monday
  • Tuesday
  • wednesday
  • Thursday
  • Friday
  • saturday
  • Sunday

• Start Date

Bank Details

• Bank Name

• Sort Code

• Account Number

• Name on Account

Medical Questionnaire

• GP Name

• GP Contact Number

• How Many days absence have you had from work in the last 3 years

• Are you currently taking or been prescribed medication (excluding contraceptives)?<br>If yes give further details

  Yes

  No

  N/A

• Do you suffer from injury, illness, medical condition or allergy that might effect your ability to perform your duties?<br>If yes give further details

  Yes

  No

  N/A

• Do you consider yourself to have a disability?<br>If yes give further details

  Yes

  No

  N/A

Identification

• Identification

  EU Passport Passport

  Non EU Passport

  Full Birth Certificate

  Right to Work

  Other

• Take a picture of ID

  Media

• HMRC Document

  P45

  P106

  Tax Code Notice

• Take a picture Of HMRC Document

  Media

• DECLERATION<br><br>I declare that the information given in this form is complete and accurate. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable for dismissal.<br><br>I understand that these details will be held in confidence by the company for the purpose of ongoing administration and compliance with the Data Protection Act 1998. I undertake to notify the company immediately of any changes to all the above details.<br><br>It is on my authority to pay my wages into the account above and failure of non payment due to wrong details will be burdened by myself.

  Yes

  No

  N/A

Authorised Signatures

• Employee Signature

  Sign

• Manager Signature

  Sign