Your Details

Your Surname (required)

Your First Name(s) (required)

Your Gender (As you identify)
FemaleMaleNon-Binary

If you chose Non-Binary above please confirm your gender as on your passport, or legal status. This is required for payroll.
Your Gender (As your passport or legal status)
FemaleMaleNon-BinaryPrefer Not To Say

Your Marital Status (required)
SingleMarriedDivorcedWidowedCivil PartnershipOther

Date of Birth (required)

Job Title

Start Date

Your Email Address

Your Home Phone Number

Your Mobile Phone Number (Required)

Your Home Address

Please attach your P45 or Starter Checklist. You can find the Starter Checklist on https://www.gov.uk/government/publications/paye-starter-checklist

Emergency Contact 1
Please complete the details of your first emergency contact. We may use this information for but not limited to the following reasons;
- Contact you if we can't contact you directly
- Inform them of an incident at work
- Share any welfare concerns we have concerning your safety both in and outside of work

You must tell your emergency contacts you have shared their details, they can submit a freedom of information request to scott@localhost at any time to see what information we hold about them.

Their Surname (required)

Their First Name(s) (required)

Their Title
MissMrMrsMxPrefer Not to Say

Relationship to you
FriendParentPartner (Married)Partner (Other)SiblingOther

Their Home Phone Number

Their Mobile Phone Number (Required)

We ask for their work office number and mobile number (if applicable) to ensure we can contact them in an emergency.

Their Work Phone Number

Their Work Mobile Number

Their Home Address

Emergency Contact 2
Please complete the details of your second emergency contact. We may use this information for but not limited to the following reasons;
- Contact you if we can't contact you directly or your first Emergency Contact
- Inform them of an incident at work
- Share any welfare concerns we have concerning your safety both in and outside of work

You must tell your emergency contacts you have shared their details, they can submit a freedom of information request to scott@localhost at any time to see what information we hold about them.

Their surname (required)

Their First Name(s) (required)

Their Title
MissMrMrsMxPrefer Not to Say

Relationship to you
FriendParentPartner (Married)Partner (Other)SiblingOther

Their Home Phone Number

Their Mobile Phone Number (Required)

We ask for their work office number and mobile number (if applicable) to ensure we can contact them in an emergency.

Their Work Phone Number

Their Work Mobile Number (Required)

Their Home Address

Reference
Please provide the details of 2 references, if you are unable to get a job reference please provide details for a charater reference from a teacher, mentor or other truested body. You much tell your reference you have shared their details.
Reference 1:
Reference 2:

GP Details
We understand declaring medical conditions, allergies or medication can feel intrusive and sometimes embarrassing. We ask you still provide your medical information to allow us to provide the best help we can. We will use this information to help provide you with an inclusive working environment. We will also share this information with 999, NHS and any emergency or medical service to allow us to arrange medical care on your behalf. This information will be available to all First Aiders. It is still not a requirement to tell us about your medical information.

Your General Practitioner (GP) name (also known as your doctors, for example Amwell Surgery)

GP address

GP Phone Number

Details of any medical conditions, allergies or tablets

Submitted forms are automatically sent to director level at Humphrey & Stretton plc for data to be processed and sent to the relevant teams. If you have any questions please contact 01992 462965 opt 0.