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CIS REGISTRATION PACK

CIS Registration

CIS Registration

Job Title

Free Text

Personal Details

First Name

Middle Name(s)

Surname

Date of Birth:

Place of Birth

Mobile Number:

Landline Number:

Email:

Home address including postcode

Postcode

Nationality

Passport/ID Number:

Right to work share code:

Are you eligible to work in the UK?

Yes

No

If yes, please give details of the documents that you hold:

Always resided in the UK

Yes

no

If No, please enter date of arrival:

Do you have any criminal records?

Yes

No

If yes, please give details

Free Text

Emergency/Next of Kin Details

Name:

Contact Number

Relationship to you

Do you have a CSCS card?

Yes

No

Colour?

Do you hold any other cards/certificates?

Free Text

Payment Details

National Insurance Number

UTR Number

Bank Name:

Account Holder Name:

Account Number:

Sort Code

Free Text

GDPR: Allied Site Services are working in conjunction with The Employment Agency Standards Inspectorate. We are therefore required by law to keep your details on record for a period of 6 Years. Allied Site Services will then archive your information after that period has passed if no work has been undertaken. Allied Site Services LTD will share your personal information with a third party umbrella company to allow you to be paid.

If you are unsure of your rights regarding this please go to https://www.gov.uk/data-protection

BY SIGNING THIS REGISTRATION FORM, YOU STATE THAT ALL YOUR DETAILS ARE CORRECT AND YOU UNDERSTAND & AGREE TO GENERAL DATA PROTECTION REGULATION (GDPR) COMING IN EFFECT FROM 25TH MAY 2018:

Date

Name:

Do you have diabetes?

Yes

No

If yes, do you need to use insulin?

Yes

No

Do you have epilepsy or fits?

Yes

No

Have you ever had blackouts, recurrent dizziness or any condition which may cause sudden collapse or incapacity?

Yes

No

Do you get discomfort, pain n the chest or shortness of breath when exercising, e.g. climbing a single flight of stairs?

Yes

No

Do you have difficulty in moving quickly over short distances, including on slopes, steps or rough ground?

Yes

No

Do you have difficulty in looking over either shoulder?

Yes

No

Do you have significant problems with your eyesight? (the requirement for wearing glasses need not be included)?

Yes

No

Do you have any difficulty hearing?

Yes

No

Are you taking any medication that causes dizziness, drowsiness, or other side effects?

Yes

No

Do you use recreational drugs – not prescribed by doctor?

Yes

No

Do you have any alcohol related illnesses?

Yes

No

Do you have a skin condition that is likely to be aggravated, or affected, by your daily work or working environment?

Yes

No

Do you have any allergies?

Yes

No

Do you have any phobias that may affect your work, e.g. fear of height, enclosed spaces?

Yes

No

Do you have any medical conditions or disabilities notifiable to the Driver and Vehicle Licensing Agency?

Yes

No

Do you, or have you, been diagnosed with Hand, Arm Vibration, Whole Body Vibration?

Yes

No

If you answer ‘YES’, does this limit use/operation of any specific equipment?

Yes

No

If you’ve answered 'YES' to any question, or have a medical condition not listed above – which may affect your work, or others, please provide details below:

Name of person completing the form

Date:

eSignature

Upload eSignature

Proof Of ID

Qualifications

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Contact us

Get in touch with Allied Site Services LTD in London for tailored recruitment solutions and permanent job opportunities throughout the country.

0208 503 1020

Allied Site Services Ltd

Unit 2 Stratosphere Tower, 55 Great Eastern Road, Stratford, E15 1DL

Registered as a LTD company under 04154603

We are open

Monday -Friday

8:00am - 5:00pm

Saturday : Closed

Sunday : Closed

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