Registration Form

Forename Surname
Tile: Mr/Ms/Mrs/Miss

Personal Details:
Date of Birth Nationality
NI Number LTD, PAYE or Umbrella
Home Tel: Mobile:
Email:
Address:
Next of Kin Next of Kin (Tel):
(Name & Relationship):

Position Required:
Position: Post Qualified Exp:
Temp and/or Perm Date Available
Hourly Rate Salary Per Annum
Notice Period Preferred Location
How did you hear of us? Availability for
Referred by? Interview
Which websites do you Consultant Name
use for job searches?

Do you have a full Driving Licence? Yes No

Do you have Proof of Eligibility to work in the UK? Yes No
Do you have a current DBS check? Date of Issue: Click here to enter a date. Yes No
Are you registered with the DBS Update Service? Yes No

Criminal Disclosure
Do you have any convictions, cautions, reprimands or final warnings which are not "protected" as defined by the
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment)(England and Wales) Order 2013?
Yes No
If you have answered yes, please choose one of the two options below on how to disclose your criminal record.

Option 1: Please provide details of your criminal record in the space below:

Click here to enter text.

Option 2: You can disclose your record under separate sheet. Please tick the box below and attach the details
in an envelope. The envelope should be marked CONFIDENTIAL and state your name and the details of the
post.

Confidentiality
As a Temporary Worker I shall:
 Keep confidential all information relating to Work Results, Intellectual Property Rights in the Work Results,
and Resourcing group’s, the Client’s or any other Resourcing group client’s business and affairs (including,
for the avoidance of doubt, Payment Rates) (“Confidential Information”) which may become known to me
in connection with the supply of the Services;
  Not use any Confidential Information except for the purposes of performing the Services;
 Without delay enter into any and all assignments of Intellectual Property Rights (relating to the Work
Results) or confidentiality undertakings that Resourcing group or the Client may require me to enter into;
 Not without the Client’s express written permission remove from the Client’s premises any material
containing any Confidential Information; and
 On request, return to Resourcing group (or as Resourcing group may direct) all material in my possession
or control and belonging to the Client or Resourcing group and/or containing Confidential Information.
Yes No
Data Protection
In accordance with the Data Protection Act to allow Resourcing group to send you regular updates of suitable
vacancies & recruitment information/services whether by letter, email, text or telephone we must request that
you indicate below your acceptance of these forms of communication. Also that you give permission to
Resourcing group to carry out a credit reference check via a credit agency where applicable Yes
No
Disclosure Declaration
In order to process your application for temporary work with Resourcing group, we may be required to disclose
all or some of your information held in your personnel file, including but not limited to your application form;
curriculum vitae; passport; birth certificate; driving license; evidence of your right to work in the U.K.;
employment references and results of criminal checks, to our clients for auditing purposes. I give my consent for
Resourcing group to disclose the contents of my personnel file, including information of any DBS Checks if
requested by the client for auditing purposes. I give consent to Resourcing group or the client to verify any of the
details disclosed and where applicable, for you to retain a copy of my DBS Disclosure Certificate.
Yes No Signed: Date: Click here to enter a date.

I declare that the information provided on this form is true and correct

Name:

Signed: Date: Click here to enter a date.

References Forms
References must be provided by an employer or work colleague for work placements covering the last two years
(five years Social Care) and we require a minimum of two references. If you have not worked before please give
the name and address of a member of your school, college or university. For permanent applicants please give
details of your last 2 positions.

Current Employer
Contact Name
Company Name
Company Phone No
Company Email
Relationship
Dates Worked From To (Month & Year)
You may contact this referee immediately Yes No
Previous
Contact Name
Company Name
Company Phone No
Company Email
Relationship
Dates Worked From To (Month & Year)
You may contact this referee immediately Yes No
Previous
Contact Name
Company Name
Company Phone No
Company Email
Relationship
Dates Worked From To (Month & Year)
You may contact this referee immediately Yes No
Previous
Contact Name
Company Name
Company Phone No
Company Email
Relationship
Dates Worked From To (Month & Year)
You may contact this referee immediately Yes No
Previous
Contact Name
Company Name
Company Phone No
Company Email
Relationship
Dates Worked From To (Month & Year)
You may contact this referee immediately Yes No

I am happy for you to contact these referees as indicated above.

Name:

Signed:

Date: Click here to enter a date.

48 Hours Opt Out Agreement

1. DEFINITIONS

1.1. In this Agreement the following definitions apply:

“Agency Worker” means the agency worker supplied;

“Assignment” means the period during which the Agency Worker is supplied to
provide services to the Client;

“Client” means the person, firm or corporate body using the services of the
Agency Worker;

“Employment Business” Eden Brown Ltd (registered company no. 3643845) of 222
Bishopsgate, London EC2M 4QD

“Working Week” means an average of 48 hours each week calculated over a 17-week
reference period.

1.2. References to the singular include the plural and references to the masculine include the feminine
and vice versa.

1.3. The headings contained in this Agreement are for convenience only and do not affect their
interpretation.

2. RESTRICTION
 The Working Time Regulations 1998 (as amended) provide that the Agency Worker shall not work on an
Assignment with the Client in excess of the Working Week unless s/he agrees in writing that this limit
should not apply.

3. CONSENT

The Agency Worker hereby agrees that the Working Week limit shall not apply to the Assignment.

4. WITHDRAWAL OF CONSENT

4.1. The Agency Worker may end this Agreement by giving the Employment Business one months notice
in writing.

4.2. For the avoidance of doubt, any notice bringing this Agreement to an end shall not be construed as
termination by the Agency Worker of an Assignment with a Client.

4.3. Upon the expiry of the notice period set out in clause 4.1 the Working Week limit shall apply with
immediate effect.

5. THE LAW

This Agreement is governed by the law of England & Wales and is subject to the exclusive jurisdiction of
the Courts of England & Wales.

Name:

Signed:

Date: Click here to enter a date.