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Step 1 of 13 - Employment type

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Personal details

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Name*

First Last

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Job title

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National Insurance Number

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Gender

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Ethnicity

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Date of birth

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New starter declaration

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Where did you hear about us

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Phone/Mobile

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Country

Type of employment required

Please select which sectors you're looking to work in:*

Warehouse & Driving

Facilities

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Industrial

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Business Support

Skills & Experience

Please select all relevant experience and skills. Ignore any that are not relevant to you.

Where marked(*), please ensure that relevant licences are produced and copied.

Supply Chain

Warehouse Operative

Van Driver/Drivers Mate

Forklift Driver

Production Operatives

Operations Management

Manufacturing & Industrial

Manufacturing Operatives

Food Production Operatives

Production Operatives

Cleaners

Quality Control

Engineers

Facilities Management

Welding/Fabrication

Retail

Retail Merchandiser

Inventory Control

Retail Assistants

Customer Service

Store Management

Commercial

Human Resources

Sales & Marketing

Administration

Finance & Accounting

Business Development

Project Management

Hospitality

Receptionist

Housekeeping

Waiter/Waitress

Porter

Concierge/Front-of-House

Chef

Management

Availability

Which areas can you work in?*

Can you work full time, part time or both?*

Can you work days, nights or weekends?*

Do you have your own transport?*

What date are you available from?*

Day

Month

Year

Employment History

Have you completed manual handling training?

Yes

Do you have an up to date CV?*

Yes

Upload your CV*

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 16 MB.

Employment History*

Employer

Date From

Date To

Reason for leaving

Position Held

Main Duties

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References

Please provide us with professional references from your former managers or coworkers.

Name*

First Last

Company*

Position*

Contact number*

Would you like to submit a second reference?

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Second Reference

Name*

First Last

Company*

Position*

Contact number*

Contract for services for the engagement of an agency worker

Between
(1) Bluestones Staffing N.I. Limited (“the company) and

(2) Contractor*

First Last

It is agreed as follows:
Interpretation and Definitions
Unless the context otherwise requires, references to the singular include the plural, and references to the masculine include the feminine and vice versa. The headings contained in the Agreement are for convenience only and do not affect their interpretation. In these Terms of Engagement the following definitions apply:

“Agreed Deductions” means any deductions the Agency Worker has agreed can be made from their pay;
“Assignment” means the period during which the Agency Worker is supplied by the Company to provide services to the Hirer. Each Assignment period will end when the Agency Worker ceases to be supplied to a Hirer or be available for work except where this relates to normal shift breaks or approved absences.
“Assignment Schedule” means the schedule or written details agreed between the Company and the Agency Worker for each Assignment containing all relevant particulars of the Assignment;
“AWR” means the Agency Workers Regulations 2010 (as amended from time to time)
“Hirer” means the person, firm or corporate body together with any subsidiary or associated company as defined by section 1159 of the Companies Act 2006 to whom the Agency Worker is supplied or introduced and includes any third party for whom the Agency Worker works pursuant to these Terms of Engagement on behalf of the Hirer.
“Qualifying Period” means the period as defined in Regulation 7 of the AWR for the Agency Worker to become entitled to the same basic working and employment conditions as defined in Regulation 5 of the AWR.
“Relevant Period” means (a) a period of 8 weeks after the last day on which the Agency Worker worked for the Hirer having been supplied by the Company; or (b) a period of 14 weeks from the first day on which the Agency Worker worked for the Hirer having been supplied by the company or 14 weeks from the first day of the most recent Assignment where there has been a break of more than 6 weeks (42 days) since any previous assignment;
“Terms” means the terms and conditions set out herein together with any Assignment Schedule to these terms;

1. The Contract
1.2 These Terms constitute the entire agreement between the Company and the Agency Worker and supersede all previous agreements between the parties in relation to the subject matter hereof and shall govern all Assignments undertaken by the Agency Worker. These Terms shall prevail over any other terms put forward by the Agency Worker.
1.3 No contract shall exist between the Company and the Agency Worker between Assignments.
1.4 No variation or alteration to these Terms shall be valid unless the details of such variation are agreed between the Company and the Agency Worker and set out in writing and signed by both parties. A copy of the varied terms shall be given to the Agency Worker stating the date on or after which such varied terms shall apply.
1.5 If there is a conflict between these Terms and an Assignment Schedule, save for where expressly stated otherwise the Assignment Schedule shall take precedence.

2. Agency Worker’s Status
2.1 During an Assignment the Agency Worker will be engaged by the Company under a contract for services.
2.2 The parties acknowledge that the Agency Worker is not an employee of the Company, and these Terms shall not give rise to a contract of employment between the Company or the Hirer and the Agency Worker.
2.3 The Agency Worker is supplied as a worker and is entitled to certain statutory rights. Nothing in these Terms shall be construed as giving the Agency Worker rights in addition to those provided by statute except where expressly stated.

3. Assignments
3.1 The Company will endeavour to obtain suitable Assignments for the Agency Worker to perform the agreed type of work shown in the Assignment Schedule.
3.2 The parties agree that the Agency Worker shall not be obliged to accept any Assignment offered by the Company, and the Company shall incur no liability to the Agency Worker should it fail to offer Assignments to the Agency Worker.
3.3 The Agency Worker acknowledges that due to the nature of temporary work there may be periods when no suitable work is available and the Agency Worker agrees that the suitability of work shall be determined solely by the Company.
3.4 For the purpose of calculating the average number of weekly hours worked by the Agency Worker on an Assignment for the purposes of the Working Time Regulations 1998 (as amended), the start date for the relevant averaging period shall be the date on which the Agency Worker commences the first Assignment.
3.5 The Agency Worker acknowledges that should the Hirer or any third party introduced to the Agency Worker by the Hirer wish to engage the Agency Worker either directly or through another employment business, before or during an Assignment or during the Relevant Period, the Company will be entitled to either charge the Hirer a transfer fee or to agree an extended hire period with the Hirer at the end of which the Agency Worker may be engaged directly by the Hirer or the third party or through another employment business.

4. Company’s Obligations
4.1 When an Assignment is offered to the Agency Worker the Company shall provide the Agency Worker with an Assignment Schedule.
4.2 If a variation to the Assignment Schedule is agreed between the Agency Worker and the Company, the Company shall provide a copy of the Assignment Schedule confirming the agreed variation to the Agency Worker by no later than 5 business days following the day on which the variation was agreed.
4.3 An Assignment Schedule may not be provided by the Company to the Agency Worker in the following circumstances:
4.3.1. where the Agency Worker is being offered an Assignment in the same position as they have undertaken within the previous five working days and the Assignment Schedule has already been provided to the Agency Worker; or
4.3.2. where the Assignment is intended to last for 5 consecutive working days or less and the Assignment Schedule has been previously provided to the Agency Worker before and the details remain unchanged. In such situation, the Company may only provide written confirmation of the identity of the Hirer and the likely duration of the Assignment. Where the Assignment subsequently extends beyond 5 working days, the Company shall provide an Assignment Schedule to the Agency Worker within 8 days of the start date of the Assignment.

5. Agency Worker’s Obligations
5.1 The Agency Worker shall during every Assignment and afterwards where appropriate:
5.1.1. co-operate with the Hirer’s reasonable instructions and accept the direction and supervision of any responsible person in the Hirer’s organisation;
5.1.2. make themselves available to the Hirer for not less than the minimum daily working hours (the Assignment Work Pattern), shown on the Assignment Schedule.
5.1.3. observe all relevant rules, policies and regulations of the Hirer site of which they are made aware, or which they might reasonably expected to ascertain;
5.1.4. take all reasonable steps to safeguard their own safety and that of any other person who may be affected by their actions during the Assignment;
5.1.5. not engage in any conduct detrimental to the reasonable interests of the Company or the Hirer including without limitation any conduct reasonably likely to bring the Company or the Hirer into disrepute, or which results in the loss of custom or business;
5.1.6. conduct him/herself in a professional manner, to dress appropriately, to wear any form of identification required by the Hirer and to observe all applicable laws; 5.1.7. at the end of the Assignment or on demand, return to the Company or the Hirer as directed, all property of the Company or Hirer including but not limited to all equipment, materials, documents (including copies) and other such materials, security passes, keys, uniforms, personal protective equipment or clothing.
5.2 If the Agency Worker is unable for any reason to attend work during the course of an Assignment they should inform the Company, prior to the working day or hours. The Hirer should be contacted where contact with the Company is not possible, but the Agency Worker must also inform the Company at the first possible opportunity.
5.3 Where the Agency Worker becomes aware of any reason why they may not be suitable for an Assignment either before the commencement of or during the Assignment they shall notify the Company immediately.
5.4 By commencing an Assignment, the Agency Worker acknowledges that he/she is not aware of anything which will cause a detriment to his/her interests and/or the interests of the Company and/or the interests of the Hirer by being engaged in such an Assignment. The Agency Worker shall inform the Company immediately if he/ she becomes aware of any circumstances which would render such engagement so detrimental. The Agency Worker will notify the Company immediately of any circumstances that might reasonably affect the willingness of a Hirer to accept his/her services.
5.5 The Agency Worker warrants that all information given to the Company as to his/ her identity, permission to work in the UK, experience, training, qualifications and authorisations which the Hirer considers are necessary, or which are required by law or by any professional body to work in the position which the Hirer seeks to fill is true and complete.
5.6 Prior to commencement of any Assignment, the Agency Worker shall inform the Company if s/he is aware that s/he has worked for the Hirer (or for any company which is a parent company of, subsidiary company of, or shares an ultimate parent company with the Hirer) including via another employment business or third party at any time since 1st October 2011 up to commencement of the most recent Assignment and if so, details of when and in what role(s), including details of any breaks between periods of work, and the reasons for such breaks.
5.7 Where an Agency Worker believes that s/he is entitled to access to collective facilities and amenities or to be informed of any relevant vacant posts with the hirer or, having completed the Qualifying Period for an Assignment, s/he is entitled to but has not received the same basic working and employment conditions (as defined in the AWR) as if s/he were directly recruited by the Hirer, the Agency Worker should discuss this with the Company or otherwise raise this in writing with the Company setting out the premise for the concern.
5.8 The Agency Worker acknowledges that any breach of their obligations under this clause may cause the Company to suffer loss and they agree that the Company reserves the right to make a claim for damages to recover such losses from the Agency Worker.

6. Timesheets
6.1 At the end of each week of an Assignment, unless instructed otherwise, the Agency Worker shall deliver to the Company a fully and accurately completed timesheet indicating the number of hours worked during the preceding week (or such lesser period) and signed by an authorised representative of the Hirer.
6.2 Subject to clause 7.3 the Company shall pay the Agency Worker for all hours worked regardless of whether the Company has received payment from the Hirer for those hours.
6.3 Should the Agency Worker fail to submit a properly completed or authorised timesheet the Company shall conduct an investigation regarding the hours claimed by the Agency Worker and the reasons for the Hirer’s refusal to sign a timesheet in respect of those hours. The Company shall endeavour to complete the investigation in a timely manner however this may delay any payment due to the Agency Worker.
6.4 The Company shall make no payments to the Agency Worker for hours not worked.
6.5 For the purposes of the Working Time Regulations 1998 (as amended), the Agency Worker’s working time shall only consist of those periods during which they undertake work for the Hirer as part of the Assignment. Subject to any amendments made to the Agency Worker’s basic working conditions during the term of this Agreement in compliance with Regulation 5 of the AWR, time spent traveling to the Hirer’s premises, lunch breaks and other rest breaks shall not count as part of the Agency Worker’s working time for these purposes.

7. Payment
7.1 The Company shall pay to the Agency Worker the rate of pay set out in the relevant Assignment Schedule which will be paid for time worked during an Assignment weekly in arrears. The hourly rate may vary but will be at least equivalent to the appropriate statutory minimum wage in force at the time for the work undertaken.
7.2 The parties acknowledge that the Company is required to make certain deductions from the Agency Worker’s pay. Pay will be subject to deductions in respect of PAYE pursuant to Sections 44-47 of the Income Tax (Earnings and Pensions) Act 2003 and Class 1 National Insurance Contributions, and any other deductions which the Company may be required by law to make and, any Agreed Deductions, and that the Company is entitled to make deductions from the Agency Worker’s pay for any overpayment of wages, holiday pay, non- returned company property and for any monies owed to the Company by the Agency Worker.
7.3 The Agency Worker may by virtue of having completed the Qualifying Period for an Assignment be entitled under the AWR to an increase in his/her pay and other emoluments and any such variation will be notified to the Agency Worker in the Assignment Schedule.
7.4 The Agency Worker agrees to comply with any requirements of the Company and/ or the Hirer relating to the assessment of the Agency Worker’s performance for the purpose of determining entitlement to any element of pay including bonuses.
7.5 Subject to any statutory entitlement under the relevant legislation referred to in clauses 9 and 10 below and any other statutory entitlement, the Agency Worker is not entitled to receive payment from the Company or the Hirer for time not spent on Assignment, whether in respect of holidays, illness or absence for any other reason unless otherwise agreed.

8. Statutory Paid Annual Leave
8.1 Subject to any increased entitlement pursuant to the AWR, the Agency Worker is entitled to paid annual leave for time worked during an Assignment according to the statutory minimum as amended from time to time.
8.2 The current statutory entitlement to paid annual leave is 5.6 weeks or, where relevant, as per the appropriate statutory minimum which applies to the role that the Agency Worker is undertaking.
8.3 In the event that the Agency Worker is entitled to an increase in paid and/or unpaid annual leave, by virtue of having completed the Qualifying Period any such increase in entitlement will be notified to the Agency Worker in the Assignment Schedule.
8.4 The Leave Year is the annual period during which the Agency Worker accrues and may take statutory leave and commences [*on the date that the Agency Worker starts an Assignment or a series of Assignments and runs until the anniversary of that date;
8.5 Unless otherwise stated in the relevant Assignment Schedule, paid annual leave accrues in proportion to the annual leave entitlement for the amount of time worked by the Agency Worker on Assignment during the Leave Year. Annual leave does not accrue for any time when the temporary worker is not working on Assignment.
8.6 Save where this clause is amended by the relevant Assignment Schedule, in the course of any Assignment during the first Leave Year, the Agency Worker is entitled to request leave at the rate of one-twelfth of the Agency Worker’s total holiday entitlement in each month of the leave year.
8.7 Unless otherwise stated in the relevant Assignment Schedule, where a Agency Worker wishes to take paid leave during the course of an Assignment they should notify the Company of the dates of their intended absence giving notice of at least twice the length of the period of leave that they wish to take. Where the Agency Worker has given notice of a request to take paid annual leave in accordance with this clause, the Company may give counter-notice to the Agency Worker to postpone or reduce the amount of leave that the Agency Worker wishes to take. In such circumstances the Company will inform the Agency Worker in writing giving at least the same length of notice as the period of leave that it wishes to postpone or reduce it by.
8.8 The Company may require the Agency Worker to take paid annual leave at specific times or notify the Agency Worker of periods when paid annual leave cannot be taken.
8.9 Unless otherwise stated in the relevant Assignment Schedule, where a Bank or Public Holiday falls during an Assignment and the Agency Worker does not work on that day, then, subject to the worker having accrued entitlement to payment for leave, the Agency Worker may upon giving notice be paid for that day as part of their annual leave entitlement.
8.10 Payment for annual leave is calculated in accordance with statutory requirements and by reference to the worker’s average remuneration for all hours worked at basic rate over the previous 52 worked weeks.
8.11 Unless otherwise stated in the relevant Assignment Schedule, all entitlement to leave must be taken during the course of the Leave Year in which it accrues and none may be carried forward to the next year. The Agency Worker is responsible for ensuring that all paid annual leave is requested and taken within the Leave Year.
8.12 Where this contract is terminated by either party, the Agency Worker shall be entitled to a payment in lieu of any untaken leave where the amount of leave taken is less than the amount accrued at the date of termination.

9. Statutory Sick Pay
9.1 The Agency Worker may be eligible for Statutory Sick Pay provided that they meet the relevant statutory criteria.
9.2 The Agency Worker is required to provide the Company with evidence of incapacity to work which may be by way of a self-certificate for the first 7 days of incapacity and a doctor’s certificate thereafter.
9.3 For the purposes of the Statutory Sick Pay scheme the qualifying days for entitlement to payment are the days on which the Agency Worker is due to work on an Assignment. Statutory Sick Pay is not payable for the first three qualifying days in a period of incapacity for work.
9.4 For the avoidance of doubt where the Agency Worker was not due to work on an assignment there is no entitlement to Statutory Sick Pay.
9.5 In the event that the Agency Worker submits a Statement of Fitness for Work or similar medical evidence, which indicates that the Agency Worker may, subject to certain conditions, be fit to work/return to work, the Company will in its absolute discretion determine whether the Agency Worker will be (a) placed in a new Assignment or (b) permitted to continue in an ongoing Assignment. In making such determination the Company may consult with the Hirer and the Agency Worker as appropriate to assess whether the conditions identified in the Statement or similar documentation can be satisfied for the duration of the Assignment. In such a case the Agency Worker’s placement in a new Assignment or continuation in an ongoing Assignment may be subject to the Agency Worker agreeing to a variation of the Terms or the assignment details set out in the Assignment Schedule to accommodate any conditions identified.

10. Termination
10.1 Either party may terminate an Assignment or these Terms at any time without prior notice or liability.
10.2 The Agency Worker acknowledges that the continuation of an Assignment is subject to and conditioned by the continuation of the contract between the Company and the Hirer. In the event that the contract between the Company and the Hirer is terminated for any reason the Assignment shall cease with immediate effect without liability of the Company (save for payment for hours worked by the Agency Worker up to the date of termination of the Assignment).
10.3 If the Agency Worker does not inform the Company or the Hirer that they are unable to attend work during the course of an Assignment pursuant to clause 6.2 this will be treated as termination of the Assignment by the Agency Worker in accordance with Clause 11.1, unless the Agency Worker can show that exceptional circumstances prevented them from complying with their obligations under Clause 6.2.
10.4 If the Agency Worker is absent during the course of an Assignment and the Assignment has not been otherwise terminated under Clauses 11.1 or 11.3 the Company will be entitled to terminate the Assignment in accordance with Clause 11.1 if the work to which the Agency Worker was assigned is no longer available.
10.5 If the Agency Worker does not report to the Company to notify their availability for work for a period of 3 weeks, the Company will forward their P45 to their last known address.

11. Intellectual Property Rights
11.1 The Agency Worker acknowledges that all copyright, title and interest of whatever nature(including but not limited to copyright and patent application rights) and all other intellectual property rights deriving from work carried by them for the Hirer in connection with an assignment shall vest in and remain the property of the Hirer throughout the world free from any interest of the Agency Worker, and the Agency Worker will do anything that the Hirer may reasonably require in order effectively to vest such rights in the Hirer or such third party as the Hirer specifies or to evidence the same (whether before or after the termination of these Terms).

12. Confidentiality
12.1 The Agency Worker may, become privy to the confidential information of the Company or any Hirer at which the Agency Worker works on Assignment.
12.2 Confidential Information shall mean any confidential information belonging to or about the Hirer or the Company, which if used by the Agency Worker other than in the course of the Assignment for the benefit of the Hirer or if disclosed to any third party either during or at anytime after the termination of the Assignment would be of value or could cause damage to the Hirer or the Company whether directly or indirectly. Confidential information is confidential if it is labelled confidential, if the Hirer expressly states (whether in writing or otherwise) to the Agency Worker that the information is confidential or if the Agency Worker ought to have known that the information may be confidential.
12.3 Unless required to do so in the proper performance of their duties, the Agency Worker must not divulge or communicate to any person; use for any purposes other than those of the Company or, as appropriate, any Hirer; or cause any unauthorised disclosure, through any failure to exercise due care and attention, of any confidential information relating to the Company or any Hirer.
12.4 The Agency Worker agrees to deliver up to the Hirer or the Company (as directed) at the end of each Assignment all documents and other materials belonging to the Hirer (and all copies) which are in its possession including documents and other materials created by them during the course of an Assignment; and
12.5 The restrictions under this Confidentiality Clause shall continue to apply after the termination of this Agreement without limit in point of time but shall cease to apply to information or knowledge which is ordered to be disclosed by a Court of competent jurisdiction or otherwise required to be disclosed by law or which comes into the public domain other than as a result of a breach by the Agency Worker of their obligations under this Agreement.

13. Data Protection
13.1 The Agency Worker agrees that the Company may collect, retain and process sensitive personal data (for the purposes of the Data Protection Act 1998) relating to them, including medical details and details of gender, race and ethnic origin.

14. General
14.1 If any provision, clause or part-clause of these Terms is held to be invalid, void, illegal, or otherwise unenforceable by any judicial body, the remaining provisions of this Agreement shall remain in full force and effect to the extent permitted by law. Any delay by the Company in responding to any breach by the Agency Worker of this Agreement shall not be deemed nor operate as a waiver of that breach. If the Company expressly waives a breach of this Agreement by the Agency Worker, this will not constitute a waiver of any future breach.
14.2 The Company shall act as a gangmaster (as defined in Section 4 of the Gangmasters (Licensing) Act) when introducing the Agency Worker into Assignments with its Clients to which this Act applies and as an employment business (as defined in Section 13(3) of the Employment Agencies Act 1973) when introducing or supplying the Agency Worker into all other Assignments with its Hirers.
14.3 All notices which are required to be given in accordance with this Agreement shall be in writing and may be delivered personally or by first class prepaid post to the registered office of the party upon whom the notice is to be served or any other address that the party has notified the other party in writing, by email or facsimile transmission. Any such notice shall be deemed to have been served: if by hand when delivered; if by first class post 48 hours following posting; and if by email or facsimile transmission, when that email or facsimile is sent.
14.4 These Terms are governed by the law of [England/ Wales/Scotland/Northern Ireland] and are subject to the exclusive jurisdiction of the Courts of [England/Wales/ Scotland/Northern Ireland] in respect of any dispute arising from these Terms or its subject matter.

In order to provide you with recruitment, payroll and related services we need to acquire and retain certain information about you as an individual. We will keep this information securely, only using it for the purposes outlined in our Terms and Conditions, and in full compliance with the prevailing data protection legislation. Where necessary, in order for us to complete our service to you - such as ensuring you’re paid for the work you do - we will securely pass your personal information to approved third-party service providers, such as payroll agencies. We only work with other businesses that are GDPR compliant, so you can rest assured your personal information is safe and secure.

From time to time, we’d like to contact you to let you know more about the services we offer, share our latest career-related blog articles or news, or let you know about exclusive offers and promotions. We’d like to do this via email, post, SMS, phone and other electronic means. We’ll always treat your personal information with the utmost care and will never sell them to other companies for marketing purposes. We will not SPAM you or bombard you with marketing communications.

I agree to the terms and conditions*

Yes

I agree to marketing communications*

Yes

Please sign here to confirm you agree with the above:*

Medical Questionnaire

The information supplied below is solely for the use of Bluestones Staffing. No details will be passed to any third parties without the express permission (in writing) of the undersigned.

Have you at any point in the last two years suffered from or received treatment from a doctor for any of the following conditions:*

Impaired Hearing

Ear Infections

Migraines or Persistent Headaches

Heart Disease, Angina

Shortness of Breath on Exertion

Faints, Dizzy Spells or Blackouts

Epilepsy

Raised Blood Pressure

Severe Back or Neck Pain

Stomach Ulcers

I have not suffered with any of the above conditions

Do you smoke?*

Yes

Do you drink alcohol?*

Yes

Do you wear glasses?*

Yes

Do you suffered a serious illness or injury in the last 12 months?*

Yes

Are you presently receiving treatment from your Doctor?*

Yes

Are you presently taking drugs or medication, prescribed or otherwise?*

Yes

I confirm that the details supplied above are true and correct to the best of my knowledge. I understand that deliberate misrepresentation may result in disciplinary action. Should my medical condition change in any respect I undertake to inform my immediate line manager immediately.

Please sign here to confirm the above statement is true:*

Next of Kin

Name*

First Last

Relationship to you*

Mobile phone number*

Home phone number

Work Time Regulations

Work Time Regulations and UK Drivers’ Hours Regulations

All mobile workers not covered by the EU drivers’ Hour Rules receive protection under UK Drivers’ Hours regulations and the horizontal Amending Directive which was incorporated into the Working Time Regulations in August 2003. The Working Time Regulations provided for;

• A 48-hour average working week (an individual opt-out is allowed)
• Four Weeks paid annual leave
• A requirement for night workers to have regular health checks
• The need for adequate rest

Please choose one of the following:*

A) You are solely working for Bluestones Staffing N.I. Ltd

B) You are working for multiple agencies on various contracts and you will inform Bluestones Staffing N.I. Ltd of any additional hours worked.

Worker seeker declaration

All Positions

Do you have any criminal record other than those ‘spent’ under the Rehabilitation of Offenders Act 1974?*

Yes

Do you have any criminal convictions pending?*

Yes

Do you suffer from any physical or mental defect or infirmity that is likely to affect your ability to carry out work in the positions for which you have applied?*

Yes

Do you have any medical conditions or any other reasons which may prevent you from working nights?*

Yes

Driving Positions

Are you applying for a driving role?

Yes

Do you suffer from diabetes, a heart condition or any other disease that may impair your driving ability?*

Yes

Have you at any point in the last 5 years been convicted of a motoring offence or have any convictions pending?*

Yes

Have you in the last 10 years had your licence suspended?*

Yes

Have you held the relevant class of licence for the positions for which you are applying for at least 2 years?*

Yes

I hereby declare that the information supplied on my Application Documents is true and correct to the best of my knowledge and that any documentation I have supplied with my application has not been falsified or altered in any way from the original document.

I undertake that should any of the information I have supplied change, in any way, that I shall inform Bluestones Staffing of this with immediate effect.

I confirm that Bluestones Staffing has supplied me with a copy of their contract for services containing an agreed minimum pay rate. Further, I confirm, they have satisfactorily advised me of my duties whilst on assignment and that it is my responsibility to ensure that I follow all procedures to ensure a safe working environment whilst on assignment. I also confirm that I have provided Bluestones Staffing with sufficient evidence for them to obtain two years checkable work history on me and that Bluestones Staffing has my consent to approach those people named by myself to obtain such details.

Whilst on assignment with Bluestones Staffing I agree to be bound by all current legislation relating to the assignments on which I may be placed. Further, whilst Bluestones Staffing will update me on occasion that this legislation changes, I understand that it is my responsibility to ensure that I work within the provisions of English Law at all times.

Please sign here to confirm the above statement is true:*

Personal Information Declaration

I acknowledge and understand that in the course of their normal business, from time to time, Bluestones Staffing may need to share some of the information supplied to them by myself.

This information will be limited to:
• Address / contact details
• Right to work documentation
• National Insurance number
• Photo Identification
• Copies of relevant accreditations or licences

I understand that any information sharing will be limited to Bluestones Staffing and its client companies and shall not be passed to third party agencies or to anyone other than for securing work for myself and demonstrating my suitability for that work.

Please sign here to confirm the above statement is true:*

Payroll information

Submitting your bank account details allows us to pay you quickly and efficiently if/when you commence working with us. All personal details submitted via our website are secure.

Bank Account Name*

Account Number*

Sort Code*

Have you ever taken out a student loan?*

Yes

When did you take out your student loan?*

Scotland, NI & pre-2012 England & Wales

England & Wales post-2012

48 Hour Opt Out

First Last

agree that I may work for more than an average of 48 hours a week. If I change my mind, I will give my employer three months' notice in writing to end this agreement.

Please sign here to confirm you agree with the 48 hour opt out:

Document uploads

Please upload the following documents:

Please upload a copy of your Passport, Birth Certificate or Right to Work.*

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 16 MB.

Please note: Passports must be valid and in date. Birth certificates must be long-form and they must be accompanied by a valid form of photographic identification.

Please upload proof of your National Insurance number.*

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 16 MB.

Accepted documents for proof of National Insurance include your NI card, P45, P60, or HMRC letter.

Please upload proof of your address.*

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 16 MB.

Documents that will be accepted as proof of address include a recent bank statement, NI letter, utility bill, P60 or P45.

Name

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