What is your proposed tax status? (Please tick). PAYE Own Limited Company Individual UTR Number. Company No: UTR No:

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1 REGISTRATION PACK. is a specialist Recruitment Consultancy providing resource solutions to the Rail, Infrastructure, Construction and Engineering Sectors. Our primary objective is to help connect the right job seeker with the right employer. Please find enclosed all the necessary forms and information we require to register you and work on your behalf. We will require you to complete and return the attached registration form, having fully read the Company Policies. Additionally, we will require copies of the following documentation. CV Current Passport Proof of National Insurance UK Working Permit/Visa (if applicable) All relevant vocational qualifications relevant to your position. Limited Company: Certificate of Incorporation VAT Certificate (if applicable) UTR Number Insurance Certificate Please note: You will not be allowed to commence assignment until all relevant documentation has been received. Please ensure that all copies of documents are clear and legible. Do not send original copies. You must attend site in person. Under NO circumstances are you authorised to substitute yourself for another person when attending site. Thank you for taking the time to register with Maple Resourcing, we look forward to working with you. If you have any questions please do not hesitate to contact us. Tel: Fax: info@mapleresourcing.com PLEASE ENSURE YOU SIGN PAGES 4, 5&7, AND TICK ALL RELEVANT BOXES. FAILURE TO DO SO WILL RESULT IN A FAILED APPLICATION Personal Details: Surname: 1 Forename:

2 National Insurance Number: Date of Birth: Information related to your date of birth is required as some positions may require age-related medicals, risk assessments etc. This information will not be used to determine your suitability for any position. Permanent Telephone number: Mobile Number: Postcode: Address For Communications (If different from above) Telephone number: Mobile Number: Postcode: Address Emergency Contact Details: (Next of Kin) Name: Relationship: Contact Number: (Home) Contact Number: (Mobile) Employment Criteria: You do not have to complete the last two questions if you are a Permanent candidate only. What employment status are you considering? (Please tick) Permanent Contract Both What is your proposed tax status? (Please tick). PAYE Own Limited Company Individual UTR Number Umbrella PAYE Own Limited Company details Company Name Company No: UTR No: Bank Details: (Personal OR Own Limited Company) Bank Name: Bank Account Name: Account Number: Sort Code Education, Qualifications & Employment History: Please provide details of your education and qualifications. You do not have to complete this section if you have submitted a current and valid Curriculum Vitae that details your qualifications and work experience. 2

3 Education & Qualifications: Qualifications: Employment History: Company Name: Title: From: To: References: Please provide contact details of at least two referees. One of the referees should be your Line Manager from your present or most recent job (or study course if no job held). Please note that references will be sought without your prior permission unless you stipulate otherwise. Referee 1: Position you held: Dates: From: To: Name of Organisation: Name & Position of Referee: Contact Number: Referee 2: Position you held: Dates: From: To: Name of Organisation: Name & Position of Referee: Contact Number: Criminal Conviction(s): Please declare whether you have a current criminal conviction, and if so, please give details of the offence(s) and sentence(s). The Company will comply fully with the requirements of the Rehabilitation of Offenders and Data Protection Acts. Do you have a current criminal conviction? (Please delete as appropriate). No 3

4 Eligibility to work in the UK: (If applicable) Under the Immigration Act 2003 we are obliged to check the eligibility to work in the U.K. of every applicant. Any person that begins an assignment or work with our clients must produce documents proving eligibility to work in the UK. Completing this section enables Maple Resourcing to assess your eligibility to work status and needs. Are you a UK Citizen? (Please tick) No If not, are you a national of an EU/EEA member country? (Please tick) No If yes, please state which one? If not, please select the statement below that applies to you: I require a work permit in order to take employment in the UK. No I hold other immigration documentation endorsed to work in the UK. No Eligibility to work outside of the UK: (If applicable) Any person that begins an assignment or work with our clients must produce documents proving eligibility to work in that specific country. Completing this section enables Maple Resourcing to assess your eligibility to work status and needs. If you plan to work outside of the UK, please tick the statement below that best describes your situation. What country or countries are you planning to work in? I hold a permit in order to take employment in the above countries. No I hold other immigration documents to work in the above countries. No Maple Resourcing Policy Acceptance I have received a copy of the full briefing of company policies: (Must Tick) 48 Hour Opt-Out Working Week Agreement Candidate Personal Data Statement Drugs & Alcohol Policy Accident & Incident Reporting Policy Environmental Policy Quality Policy (Generic) Equal Opportunities Policy Health & Safety Policy First Aid Policy I fully understand and accept the content of the Policies and will endeavour to adhere to the standards expected of me. Name: Signature: Date: CONDUCT REGULATIONS OPT OUT NOTICE LIMITED COMPANY & UMBRELLA CONTRACTORS ONLY 4

5 NOTE TO LIMITED COMPANY & UMBRELLA CONTRACTORS: Limited company contractors can opt out of the Conduct of Employment Agencies and Employment Businesses Regulations 2003 (in England, Scotland and Wales) or the Conduct of Employment Agencies and Employment Businesses (Northern Ireland) Regulations 2005 (in Northern Ireland). If, you, the Intermediary, and the Agency Worker to be supplied to do the work wish to opt out of the Conduct Regulations, please read this form carefully. It is recommended that you take independent legal advice so that you know what the opt-out means for you. In this opt out notification we use the terms Intermediary and Agency Worker to mean the limited company and the limited company contractor respectively. These are terms used in the Agency Workers Regulations 2010 (in England, Scotland and Wales) and the Agency Workers (Northern Ireland) Regulations 2011 (in Northern Ireland). Parties: (1) Company/Umbrella Name: Company Number: (the Intermediary ) (2) Name of individual supplied to do the work: of address: (the Agency Worker ) 1. This Opt Out Notification is supplemental to the agreement ( the Agreement ) between Maple Resourcing Ltd and the Intermediary. The terms used in this notification shall have the same meaning as those defined in the Agreement. 2. The Intermediary and the Agency Worker acknowledge that it is their intention that the provisions of the Conduct of Employment Agencies and Employment Businesses Regulations 2003 or the Conduct of Employment Agencies and Employment Businesses (Northern Ireland) Regulations 2005 (the Conduct Regulations ) do not apply to any [future] assignment agreed between the Parties. 3. The Parties have freely entered into this Opt Out notification. 4. Further that the Intermediary and the Agency Worker are free to withdraw from this Opt Out notification at any time by giving not less than one weeks written notice to. However, where notice is given during an Assignment it will not take effect until the Individual stops working in that Assignment and commences a new assignment. 5. We the undersigned have read, understand and agree to be bound by the terms of this Opt Out notification. In particular, we understand that by signing this Opt Out notification we are agreeing that the provisions of the Conduct Regulations shall not apply to any future assignment agreed between the Parties. Signed For and on behalf of the Intermediary Position: Signed The Agency Worker I confirm I am authorised to sign this Opt-Out Notification for and on behalf of the Intermediary. Disability: The Disability Discrimination Act 1995 and the Disability (Employment) Regulations 1996 are designed to protect disabled people from discrimination in the field of employment; protect people who no longer have a disability but had one in the past and replace the 1944 Disabled Persons (Employment Act). To be protected against discrimination under the Act, individuals must either have, or have had, a disability. A person has a disability if he or she has a physical or mental impairment; the impairment has an adverse effect on his/her ability to carry out day to day activities; the effect is substantial or the effect is long term. 5

6 Do you consider yourself to be disabled? (Please tick) No If yes, please indicate briefly the nature of your disability. If you are appointed to this post, do you feel that any special aids or equipment would be required to take account of your disability? Please give details. Self-certification Medical Declaration: In order to comply with particular health and safety requirements, it is important that you declare any medical conditions or concerns that you have that may impact on your ability to perform particular roles in a safe manner. Please circle the appropriate answer: You do not have to complete this section if you are a Permanent candidate only. 1. Do you have Diabetes and require Insulin? No 2. Do you suffer from Epilepsy or any other type of fits? No 3. Have you ever had black-outs, recurrent dizziness or any condition which may cause sudden collapse? No 4. Do you have any discomfort or pain in your chest or shortness of breath? No 5. Do you have difficulty in moving rapidly over short distances, including on slopes and rough ground? No 6. Would you have difficulty in looking over your shoulder? No 7. Would you have difficulty in working in out-door, open areas? No 8. Would you have difficulty in working in enclosed spaces? No 9. Would you have difficult in working at height? No 10. Are you required to wear glasses? No 11. Do you carry a spare pair of glasses when working on site? No 12. Do you have difficulties in correctly identifying colours? No 13. Do you have difficulties with hearing? No 14. Are you taking any prescribed or non-prescribed drugs or medication? No 15. Have you had any alcohol or drug related problems or illnesses within the last 12 months? If you have answered yes to any of the above questions, please can you provide any necessary details with supporting documentation and record any relevant details below: No Date Started Medication Dosage Course of Treatment Any Side Affects? Reasons for Taking Prescribed by Doctor (Y/N) Supporting Information: Please enclose legible photocopies/scanned copies of any relevant supporting information relating to your registration. It is important to make the original documentation available for inspection by an appropriate Maple Resourcing representative. Please tick the applicable boxes that correlate with the supporting information you are providing. It is a legal requirement for Employment Businesses and Employment Agencies to verify your application prior to introducing you to a company. 6

7 Qualification/Training/Competency Certificates Limited Company Documentations (C.O.I.) VAT Registration Certificate (if applicable) Insurance Documentation Curriculum Vitae Professional Memberships Medical Certificate (if applicable) Pre-employment Alcohol & Drug Screening Work Permit or Work Visa (if applicable) National Identity Card A full birth certificate A full adoption certificate (if applicable) Name change certificate (if applicable) National Insurance Number Driving Licence (if applicable) Immigration documentation Valid (in-date) Passport Criminal convictions No If yes, please advise details Maple Resourcing acknowledge that some information and documentation required is sensitive and the importance of maintaining high levels of information security. If you do not have copies of the relevant documentation needed, as listed above; please contact the Contracts and Training Team to discuss what options are available. Verification: Maple Resourcing Limited is required under clause 19.b of The Conduct of Employment Agencies and Employment Businesses Regulations 2003, to confirm the experience, training and qualifications of a candidate before we place them. We are required to contact each university, college, institute or company through which training or qualifications are done or professional accreditation or membership is attained. Although the Data Protection Act 1998 (under clause 35.1) allows us to request this information without permission, some companies are reluctant to release any information without your consent. This can significantly slow down our ability to place you in a position. We are therefore requesting that you provide us with permission to verify your qualifications etc, by signing the declaration below and returning it to as soon as possible. The information that you provide on this form and on any CV given will be used by to provide you work finding services. In providing this service to you, your consent to your personal data being included on a computerised database and consent to us transferring your personal details to our clients. We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other way permitted or required by law. I, (Print Name) hereby give a representative of Maple Resourcing Ltd permission to verify any qualification, accreditation, membership, reference, training, etc, that I have disclosed and that they may be required to do under the Conduct of Employment Agencies and Employment Businesses Regulations I can confirm that I have read all of the documentation and understand all of the contents within. I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients. I consent to references being passed onto potential employers. If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that will be entitled to charge the client an introduction/transfer fee. Signed: Date: 7