Q-TRACK

Contact Information

If you have completed this form before, click

First Name

Last Name

Phone Number

DOB

Post Code

Address Detail

Town

County

Allows third party data share

Yes No

Main Page

SECTION 1 - Next of Kin/ Emergency Contact Information

Please tell us who to contact in an emergency

Full Name of person to contact:

Contact Telephone Number:

Relationship to you:

SECTION 2 - Employee Statement

Tell us about your current status

Please upload your P45 here if applicable

Add file

If you do not have a P45 please tick one of the following:

This is my first job since last 6 April and I have not been receiving taxable jobseekers allowance, employment and support allowance, taxable incapacity benefit, state or occupational pension.

This is now my only job but since last 6 April I have had another job or received taxable jobseeker's allowance, employment and support allowance or taxable incapacity benefit. I do not receive a state or occupational pension.

As well as my new job, I have another job or receive a state or occupational pension.

I have a student loan which is not fully repaid and I left a course of UK higher education before last 6 April and I received my first student loan instalment on or after the 1 September 1998 (select NO if you are repaying your student loan direct to the student loans company by agreed monthly instalments)

Yes

SECTION 3 - Bank and personal Details

Please note the account should be in your name. Our team will check against the information provided.

Bank/Building society name

Bank/Building society address

Nationality

Account holders full name

Account number (8 digits)

Sort Code (6 Digits) / Roll Ref. No (for building society accounts only)

Your Ni number:

Please state your gender

Do you confirm that bank details provided by you are correct?(WB employment does not take responsibility for payments sent to incorrectly provided bank details)

SECTION 4 - Employment and Activity History

Note: Activity history must be provided by all applicants covering the last two years. (Please include all work; education history & periods of unemployment).

1. Full company name and location:

Contact Name:

Contact Telephone Number:

Contact Position:

Contact Email Address

Employment Dates From and to:

Duties:

Reason for Leaving

2. Full company name and location:

Contact Name

Contact Telephone Number

Position:

Employment Dates From and To:

Duties:

Reason for Leaving:

If you require additional space please use this box to enter additional roles or information:

SECTION 6 - Contract Acceptance

Please confirm and provide answers to the following:

I confirm that I have read, understood, accept and downloaded a copy of the TEMPORARY COLLEAGUE CONTRACTUAL TERMS (Contract for Services)

Download your Terms Here:
Download File

I confirm that I have read, understood, accept and downloaded a copy of the Mobile Workers Declaration

Yes

Please download and read the mobile workers declaration here:
Download File

Enter if applicable Employer/Employment Business Names During the Start of the Current Reference Period to Date

The Total Weekly Working Time to be Taken into Account for Each Employer/Employment Business. (EG EMPLOYER NAME, 12 Hours)

I DECLARE THAT: I have accurately detailed all my Working Time during the current reference period in the above and that it is true and correct to the best of my knowledge.; Please confirm if you are engaged in any work, other than for WB Employment which needs to be included in the calculations of your Working Time under the RTWT Regulations; and I will keep WB Employment informed in writing as to the details of Working Time undertaken for other employers or employment businesses on a weekly basis; and I will inform WB Employment immediately if there are any changes to my situation which impact on my Working Time.

I AM NOT Currently engaged in any work other than for First Call Contract Services

I AM Currently engaged in other work other than for First Call Contract Services

I confirm that I have read, understood, accept and downloaded a copy of the 48 Hour Working Week Opt-out Agreement

Yes

Please download and read the 48 Hour Opt Out Here:
Download File

Key information Details
Download File

Signature

I declare that the information contained in this application for work has be freely provided and to the best of my knowledge is true and accurate. I understand that it is an offence to knowingly provide false information to an employer for the purpose of obtaining work by deception. I confirm that I will inform WB Employment of any changes to my personal details should they occur.

Print name:

Date:

Additional Details

If you require additional space to provide further information please enter below

Please enter additional information below if required: