Personal Information

Title (required):

First Name (required):

Middle Name:

Last Name (required):

Address Line 1 (required):

Town (required):

Postcode (required):

Mobile Number (required) – (11 Digits, no spaces):

Email (required):

Date of Birth (required):

Are you eligible to work in the UK? (required):

How would you get to work?

NI Number:

Where Did You Hear About Us?:

If Other, Please State:

Account Holders Name:

Bank/Building Society:

Sort Code - (6 Digits):

Account Number - (8 Digits):

Tax Declaration

Please select one of the following:
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 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.

Convictions and Medical

Do you have any unspent criminal convictions?:

Have You Any Pending Court Cases Or Awaiting Sentencing For Any Criminal Activity?

Have You Ever Had Any Of The Following (Please select Yes or No) - (required):
Heart Problems
A Stroke
Diabetes
Epilepsy
Back Problems
Dermatitis or Skin Allergy
Asthma
Hernia
Eye Problems
Hearing Problems
Headaches or Migraines
Arthritis

Do You Take Any Medication That May Affect Your Assignment:

Emergency Contact

Full Name:

Telephone Number:

Disclosure: Some clients need personal documentation or information regarding your skills, licenses etc.

Please choose one of the following options below to authorise City Resource to disclose this information if asked: