Personal Details

  • Name

  • Photograph

  • Address

  • Mob.No.

  • Tel.No.

  • Email

  • Date of Birth

  • National Ins.No

  • Job Title

  • Site

  • Start Date

Next of Kin

  • Name

  • Contact Tel.No.

  • Relationship to Employee

About You

  • Do you hold a Driving License

  • Date of Issue

  • Category

  • Do you have any holidays booked

  • From

  • To


  • Proof of Current Address - Please provide one of the following documents as proof of address

  • Length of time at this address


  • I declare that I have provided documentation showing my true address. I further declare that I will complete a ‘Change of Address’ form if my circumstances change during my continued employment with Concept Services (NI) Ltd

  • Employee Signature


  • The Working Time Regulations 1998 that no adult worker (over the age of 18), is required to work more than 48 hours per week averaged over 17 weeks. Workers can however voluntarily agree to work more than the 48 hours limit by signing an ‘Opt Out’ agreement

  • I agree that the limit of 48 hours per week specified by the Working Time Regulations Regulations does not apply to my employment with Concept Services (NI) Ltd. I understand I that I can withdraw my agreement by giving 3 months notice in writing if I wish to Opt Out

  • Young Workers - Please note - If you are categorised under ‘Young Worker’ (aged 16-17 years) you cannot opt out of the maximum weekly and daily hours limits imposed by the Working Time Regulations 1998

  • If you do not ‘opt out’ of the 48 hour limit and you obtain additional employment, then you will need to complete a new form obtained from your supervisor.

P45 - P46

  • Relevant Tax Form - If no P45 is available the new starter MUST complete a P46

  • Attach

  • Give Starter a P46 to complete then take a photograph of the completed document

  • National Insurance No.

  • Date of Birth

  • Title

  • Surname - Block Capitals

  • First Name

  • Second Name

  • Gender

  • House/Flat No.

  • Address

  • Postcode

  • Read the following statements carefully and answer YES or NO as appropriately

  • A - Is this your first job since last 6th April you have not been receiving taxable Jobseekers Allowance, Employment and Support Allowance or taxable Incapacity Benefit or a state Occupational Pension

  • B - This is now my only job, but since last 6 April I have had another job or have received taxable Jobseekers Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a state Occupational Pension

  • C - I have another job or I receive a state Occupational Pension

Student Loans (Advanced in the UK)

  • If you left a a course of UK Higher Education before last 6 April and received your first UK Student Loan instalment on or after 1 September 1998 and you have not yet fully repaid your Student Loan enter X. (Do not enter X if you are repaying your UK Student Loan by agreement with the UK Student Loans Company by making monthly payments through your bank or building society account

  • Signature

  • Date


Right to work in UK

  • Are you currently authorised to work in the UK

  • Have you any Visa Restrictions

  • Visa No.

  • Visa Expiry Date

  • Visa Type

  • From

  • To

Guidance Notes

  • Documentation from List One or List Two must be provided prior to the employee’s first shift.

  • Original documentation must be provided and a photograph taken by the supervisor. This part of the process must be completed in in full and signed by both the Employee and Supervisor. If this is not completed then NO payment can be processed until the required documentation is provided.

  • If you are unsure of the documentation required or have any issues or queries regarding this documentation then please contact HR Department on 028 9061 0999 for further advice.

List One

  • Evidenced of ‘Right to Work - UK’ (One Document please)

List Two - Combination One

  • Evidenced of ‘Right to Work - UK’ (Two Documents please) One from Blue - One From Yellow

List Two - Combination Two

  • Evidenced of ‘Right to Work - UK’ (Two Documents please) One from Blue - One From Yellow


  • I declare that I have provided legal and official documentation. I further declare that I will continue to provide legal and official documentation during my continued employment with Concept Services (NI) Ltd

  • Employee Signature

  • Concept Representative


Contract Details

  • Rate of Pay - Daily

  • Salary (if applicable)

  • Weekly Hours

  • Shift - Monday

  • Shift - Tuesday

  • Shift - Wednesday

  • Shift - Thursday

  • Shift - Friday

  • Shift - Saturday

  • Shift - Sunday

Declaration - Employee

  • Any false declarations in this documentation will result in immediate contract termination and will result in a delay to payments due until satisfactory due process has been concluded. I acknowledge that my employment is subject to a 12 months probationary period after which my performance will be reviewed, at which time my probationary period may be extended. I also understand that my employment is subject to health checks as deemed necessary. *Access NI Clearance may be required for some roles; policies and procedures for application are available through the HR Department.

  • Employee Signature

Declaration - Supervisor

  • I hereby confirm that I, on behalf of Concept Services(NI) Ltd, have been provided with all required legal and company required documentation in their original format (no copies) as proof of their legal entitlement to work in this country. I have checked that this form has been completed correctly and in full and I therefore authorise, on behalf of Concept Services (NI) Ltd, this employee to commence work.

  • Concept Representative


    Previous Employment
  • Please list details of all positions previously held, starting with your most recent covering the last 5 years

  • Company Name

  • Company Address

  • From

  • To

  • Position Held

  • Reason for leaving

  • Education History
  • Please list details of any relevant education and / or qualifications obtained

  • College Name

  • College Address

  • From

  • To

  • Qualifications - (please state grade attained)

  • References
  • Please list details of any references you wish us to call on. One must be your previous employer. If you have not been employed before please provide details of professional persons who can provide a character reference (eg teacher, lecturer etc.). Please provide Full details for all referees. All offers of employment are conditional upon receipt of satisfactory references.

  • Name of Referee

  • Position of Referee

  • Company Name

  • Company Address

  • Have we permission to contact the references prior to interview

Additional Information

  • Do you require any special arrangements or adjustments to be made for you interview or assessment

  • Please give brief details of your requirements

  • Please ensure you seek the appropriate advice / information regarding disclosure before completing the next two questions

  • Are you subject to any pending criminal prosecutions (including driving )

  • Please give detail

  • Have you ever been convicted of a criminal offence that is not regarded as being spent under the Rehabilitation Act 1974

  • Please give details

  • Employee Signature



  • Under the Disability Discrimination Act 1995 you are deemed to be a disabled person if you have cancer, multiple sclerosis or HIV infection.
    Also, you are deemed to be a disabled person if you have a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities.

  • Do you consider yourself to be a disabled person

  • Please indicate the nature of your impairment

  • Please give further details

  • Concept Services (NI) Ltd is a Facilities Management company and as such lifting and carrying is an intrinsic part of almost all roles within the business. Working on clients sites and company premises will involve daily and regular lifting of items of varying weight and size. Please inform us of any circumstance which may effect your ability to undertake this extent of manual handling

  • Please give details

  • Employee Signature



  • By signing this form you are consenting to Concept Services (NI) Ltd holding and processing your personal data for the following purposes: -
    1. Maintaining an accurate record of your employment
    2. Paying your wages
    3. Monitoring your attendance
    4. Monitoring your work activities, performance etc.
    5. Ensuring you are capable of performing your role
    6. Ensuring you are not barred from performing you role
    7. Safeguarding your health, safety and well-being in work
    8. Complying with Employment Law
    9. Complying with Health and Safety Law
    10.Access NI Clearance
    11. Complying with other law that will apply from time-to-time
    We will from time-to-time need to share your personal information with external agencies including HMRC, the ICO, HSE, Courts and Tribunals and our legal and professional advisers. By signing below you also consent for this sharing. Sharing will only take place where we are confident that the organisation has robust data protection policies and procedures in place to protect the data that is shared with them.
    We may use your personal data from time to time for the above purposes. This may also include contacting you by phone, text, post or email regarding your employment.

  • Employee Signature


Personal Appearance & Hygiene

  • All employees will be provided with a uniform (excluding shoes and trousers/skirts). It is the responsibility of the employee to keep their uniform washed and ironed and to carry out minor repairs as necessary. The uniform remains the property of the Company and should be returned if the employee leaves. If an employee fails to return their full uniform a deduction will be made from their final salary.
    Where an employee is not provided with a uniform, the expectation is that they will present themselves in appropriate business attire and in a manner that will meet with employer, colleague and customer expectations.
    Employees are required to wear shoes which are flat with a slip resistant sole and which are covered at both toe and heel. Open sandals, flip flops or trainers are not permitted.

PPE Supplied

  • Our policy is that at all times when on a Client’s site that requires PPE these items must be worn. Failure to do so may lead to disciplinary action being taken.

Standard of Appearance

  • Our policy is that at all times when on a Client’s site that requires PPE these items must be worn. Failure to do so may lead to disciplinary action being taken.

Cleaning Division

  • Uniform

Service Division (Hygienics & Pest Control) Janitorial Division (Warehouse)

  • Uniform

  • All supervisors and managers will complete uniform checks for all staff. If a member of staff requires additional uniforms please ask your manager or supervisor. Please note that additional items may be charged for. Uniforms can be replaced as and when required, however, you are expected to ensure your uniform is properly cared for and not unnecessarily damaged. on the basis of old and worn. Your manager will assist you with any of your concerns.

  • Thi ‘Uniform Policy’ has been read and explained to me and I confirm I understand the information contained within it

  • Employee Signature

  • Concept Representative


Standard Issue / Order Form

  • Polo Shirt

  • Jumper

  • Trousers

  • Fleece

  • Coat

  • Body Warmer

PPE Issue / Order Form

  • Safety Boots

  • Hi Viz Vest

  • Overalls

  • Safety Glasses

  • Face Shield

  • Ear Protectors

  • Puncture Gloves


  • Site Keys

  • Car / Van Keys

  • Phone / Charger

  • iPad

  • Laptop

  • Fuel Card

  • Card No

  • Expiry Date

  • I hereby agree that I have received the uniform, Personal Protective Equipment and other items listed above and that I am responsible for the ongoing care, the correct usage and maintenance of all items.
    I further acknowledge and agree that:
    Should any item be lost or deliberately damaged (other than fair wear and tear), I will be required, at the sole discretion of The Concept Group, to meet the replacement cost.
    Should I, on termination of my employment, fail to return all the items or return them in a deliberately damaged or dirty condition, Concept Group may deduct the cost of cleaning and/or replacement from my final wages or entitlement.

  • Employee Signature

  • Concept Representative


Safety Induction

  • To be completed before employee commences work on any site

  • Explain the employee safety obligations (refer to the OH&S policy)

  • Provide Safe Working Method Statements (SWMS) applicable to the position

  • Show location of the Material Safety Data Sheets (MSDS)

  • Review Site PPE requirements ( show where it is stored)

  • Discuss employee’s individual needs to complete their tasks

Site Induction

  • To be completed by a Client Representative, before employee commences work on any site

  • Explain any Site specific Rules & Regulations

  • Identify staff areas

  • Complete The Concept Group induction

  • Explain Quality Management System (QMS)

  • Explain Environmental Management System (EMS)

  • Client Signature

Emergency Procedures

  • To be completed by a Client Representative and Concept Supervisory staff before employee commences work on any site

  • Explain Emergency Evacuation procedures

  • Show Emergency ‘Muster’ points

  • Explain ‘suspicious packages / threats Reporting process

  • Explain Phone Call / Alarm process in the event of an emergency

  • Explain Reporting process in the event of an emergency

  • Client Signature

  • Employee Signature

  • Concept Representative


Employee Declaration

  • I hereby undertake with respect to any information supplied in any form whatsoever about Concept Services (NI) Ltd (Also referred to as The Concept Group) and any of its companies or Clients, (Current, Proposed or Tendered) contained within the Company Management System (CMS), Human Resources, Tender Documents or any other information medium and to hold such information confidential. I will not discuss such information either publicly or communicate such information to any other person or body either directly or indirectly except with the express permission of the said party supplying the information to me in pursuant of this agreement.

Confidentiality Statement

  • I acknowledge that as, during the course of my employment, I may have access to or gain knowledge of confidential, sensitive or personal information concerning The Concept Group, The Concept Groups Staff and other visitors and/or the affairs of The Concept Group and its Clients:
    I owe a duty of confidentiality to my employer and, in accordance with The Contracts (Right of Third Parties) Act 1999 and that therefore;
    All information gained whilst carrying out my duties must be treated as confidential. I agree that I will not, at any time, disclose or make use of any such confidential information;
    Any contact with the Press or any media agency in relation to any business of my employer, and/or the clients operations and their clients, customers or employees is strictly forbidden;
    No public statements to the Press or any media agency may be made by me without the authorisation, at director level, of my employer or any of their clients;
    I undertake not to provide any quotation or information regarding any knowledge gained during the course of my employment to any third party and specifically not to any party who have, or be reasonably suspected of having, any relationship with a member of the Press or any media agency in the UK or worldwide.
    I undertake not to provide freelance services to, or seek employment of any Concept Group clients, if I am already employed by any press or media organisation or agency, and I will not use my employment at The Concept Group for any press or media related purpose.

False Information (Theft Act 1968: Section 16 (1))

  • I am aware that the provision of false or deliberately incorrect curriculum vitae (CV) or any other false information or document(s) for the purpose of obtaining employment is serious misrepresentation and is likely to constitute a criminal offence.

  • Employee Signature


Equal Opportunities

  • EQUAL OPPORTUNITIES: Concept Services (NI) Ltd is an Equal Opportunities employer and positively encourages applications from candidates regardless of their sex, race, abilities, age, sexual orientation, gender reassignment, religion, beliefs, community background, marital status and maternity.


  • REFERENCES: Concept Services (NI) Ltd will obtain references as required to support this application or continued employment from educational and employment sectors in addition to any referees you have provided above.

Basic / Enhanced Disclosure

  • BASIC / ENHANCED DISCLOSURE: Concept Services (NI) Ltd may require an applicant or employee to complete documentation to enable the company to apply for a Basic / Enhanced Disclosure to support their application or continuing employment with the company. The company can request a Basic / Enhanced Disclosure showing details of all convictions considered unspent under the relevant rehabilitation of offenders legislation, or state that there is no such convictions. A Disclosure will provide information to Concept Services on spent convictions, cautions, membership status, consideration status, suitability information, prescribed court orders and sex offenders notification requirements, other relevant information, information about last Access (NI) scheme record or information about changes to vetting information.

Personal Declaration

  • PERSONAL DECLARATION: I also agree to Concept Services (NI) Ltd obtaining or requiring me to obtain, a Basic Disclosure from Access (NI), as Concept Services (NI) Services Ltd considers it appropiate, which I understand may identify any unspent convictions or cautions. I confirm that all information provided by me in support of my application is to the best of my knowledge, accurate and true. I understand that an unsatisfactory Access NI certificate, and/or any false or misleading information provided as part of the recruitment process, or any failure by me to disclose information requested may result in an offer being withdrawn or to disciplinary action being taken upto and including dismissal without notice. Concept Services (NI) Ltd, have an Ex offenders policy, this can be obtained by request, via email

  • Employee Signature


CHECKLIST - Legally required documentation - Any delays in providing the correct documentation will result in a delay in your payments

  • Working Time Regulations Form

  • Tax Form

  • Right to Work in UK

CHECKLIST - Company required documentation - Any delays in providing the required documentation will result in a delay in your payments

  • Proof of Current Address - (Bank Statement or Utility Bill)

  • New Starter Form - Complete in full

  • Company Application Form - Complete in full

  • Medical Questionnaire - Complete in full

  • Monitoring Form - Complete in full

  • Confidential Agreement

  • GDPR Information

  • Staff Handbook

  • Uniform Policy

  • Uniform / Equipment Issue Form

  • Employee Induction Record

  • Employee Training Record

  • Actions
  • Action

  • Concept Representative

  • Employee Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.