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):

Home Number Inc Area Code – (11 Digits, no spaces):

Email (required):

Date of Birth (required):

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

Are you seeking Industrial/Technical/Commercial work? (This includes forklift truck driving - required):

If Yes, do you agree to opt out of the Working Time Regs 48-hour limit? (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):

Roll Number/Ref (If Any):

Employment History

Job Title and Company:

Start Date Title:

End Date:

Job Description:

Add Additional Job

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

Have You Ever Been Convicted Of A Criminal Offence? If Yes, Please State (required):

Have You Any Pending Court Cases Or Awaiting Sentencing For Any Criminal Activity?
If Yes, Please State (required):

Have You Ever Been Involved In Any Circumstances Likely To Bring Either City Resource Ltd Or Its Clients Into Disrepute?:

Do You Consider Yourself To Have A Disability? If Yes, Please State (required):

Doctors Name:

Doctors Address Line 1 (required):

Doctors Address Line 2:

Doctors Town (required):

Doctors Postcode (required):

Have You Ever Had Any Of The Following (Please select Yes or No) - (required):
Heart Problems
A Stroke
Diabetes
Epilepsy
High Blood Pressure
Back Problems
Black Outs or Faints
Dermatitis or Skin Allergy
Asthma
Hernia
Stomach Problems
Varicous Veins
Nervous Disorder
Eye Problems
Dental Problems
Hearing Problems
Headaches or Migraines
Arthritis
Repetitive Strain Injury

Have You Recently Had Your Eyes Tested (required):

Do You Take Any Medication? If Yes, Please State (required):

How Many Sick Days Have You Had In The Last Two Years? (required)

What Were The Causes Of The Sick Days? (required)

Do You Smoke? (required)

What Physical Exercise Do You Undertake? (required)

Next Of Kin

Full Name:

Home Telephone Number:

Mobile 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:

If you are a Driver, please check the linked Terms and Conditions and confirm you accept by ticking this box here.

If you are Self Employed, please check the linked Terms and Conditions and confirm you accept by ticking this box here.

For other job types, please check the linked Terms and Conditions and confirm you accept by ticking this box here.