Consultant

Which consultant are you registering with*

Personal details

First name* Last name* Address Postcode Town Mobile number* Your email*

National Insurance Date of birth Nationality* Gender identity Pronouns

Emergency contact/ Next of kin

Name*

Contact*

Employment

Upload your CV

Accepted file types: .doc, .docx, .pdf
Maximum file size: 1MB

References

1. Please give the names and addresses of two recent employers. If you are unable to do this, please answer question 2 at the bottom of the page.
We reserve the right to contact any of your other previous employers within the last three years.

Reference 1

Name* Job title* Organisation* Address* Contact number* Email* How is this person known to you?*

Reference 2

Name Job title Organisation Address Contact number Email How is this person known to you?

2. If you are unable to provide two recent working references, please give reasons? 3. If in current employment what is your notice period?

Questionnaire

Please list up to 3 job roles you are interested in? (Please only list jobs you have relevant experience in)* What hours / days of work are you looking for? What are your salary expectations? Please list the locations in which you are seeking employment? Please provide any additional information regarding your experience in the roles you seek?

Declarations*

Do you have any health issues including mental health, disabilities or pending operations that we need to be made aware of in relation to the roles you seek? yesno If yes, please specify

48 hour Opt out rule for staff over the age of 18

Do you agree that you may work for more than an average of 48 hours a week? If you change your mind, you will give your employer notice in writing to end this agreement. yesno

Criminal Convictions*

Unspent criminal convictions? yesno If yes, state convictions and dates

(NB Certain types of employment and professions are exempt from the Rehabilitation of Offenders Act 1974 and in those cases particularly where the employment is sought in relation to positions involving working with children or vulnerable adults, details for all criminal convictions must be given. The information given will be treated in the strictest of confidence and only taken into account where, in the reasonable opinion of [insert company name], the offence is relevant to the post to which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light)

Starter declaration*

Tick one of the following three statements

This is my first job since last 6 April and I have not been receiving taxable Jobseeker's 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, 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.

Student loans

No student loanI make Type 1 Student Loan repayments through payrollI make Type 2 Student Loan repayments through payroll

Employment start date

Declarations*

I agree that Adkins & Cheurfi Ltd can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998. I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or employment terminated. I can confirm that Adkins & Cheurfi Recruitment ltd has been authorised to hold my CV and approach companies as discussed with my agent on my behalf to find me permanent employment. Additionally, I confirm that I have not applied directly to any of the companies that we agreed to approach nor have I authorised any other Recruitment Agency or third party consultancy to submit my details for consideration for any of these position during the last 12 months.