First name

Surname

Mobile Number

Home Number

Email Address

Address

Driving Licence

Do you have your own transportation?
YesNo

Education

Establishment

To

From

Qualifications

Grades

Establishment

To

From

Qualifications

Grades

Employment History

Establishment

To

From

Address of employer

Position

Salary

Reason for leaving

Contact name

Contact number

Contact email

Personal reference

Personal reference

Requirements

Type of work

Role

Minimum salary

Preferred locations

Would you relocate?
YesNoPossibly

Notice period

Do you have any health issues or a disability relevant to the position or role you seek?
YesNo

If yes, please specify

Agency Workers Regulation: In order to ensure you receive your full rights under the Agency Workers Regulations 2010, have you, in the past 6 weeks been hired by an employment business to carry out work for their clients?
YesNo

If yes, please specify

Have you taken time off the assignments with the other employment business which may impact your qualifying period rights under the Agency Workers Regulations?
YesNo

It is your responsibility to let Fortius Recruitment know if you take on any work through another agency while you are engaged by us
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Do you have any unspent criminal convictions?
YesNo

If yes, please specify

Your Details

Some information provided on this form may be classed as sensitive data under the Data Protection Act 1998, for this we need your explicit consent to hold this information. By signing this declaration, I consent to you holding data and processing data under the rules of the Data Protection Act 1998. The name of the data registrar is available on request. I consent to my information being used for work-finding services and you may contact me by:

EmailLetterTextPhone

I understand that during and after an assignment:

1. I will keep secret and confidential all information made available to me about any customer, any member of staff or the business of the client(s) I have been assigned to

2. I will keep all such information securely and will not disclose it nor allow it to be disclosed to any unauthorised person

3. Upon completion or end of my assignment, I will return all property, ID, paperwork and any associated items to a representative of yours or the client’s representative.

4. I understand that the above undertakings are terms of my assignment and should I break any of them, this may result in action, not excluding Civil or Criminal Prosecution being taken against me. This includes the Data Protection Act 1998 and any variations that may be made to this in the future

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By signing this document, I confirm that I have read and fully understand the statements above and agree to abide by them. I also declare that all the information I have given is true and accurate to the best of my knowledge. I understand that failure to declare an accurate account of my working history may invalidate any claim I may have under the Agency Workers Regulations 2010.

I agree
I agree