Centrum Care Homes Payroll Information Form
Please complete this form so that we have your details to process payroll
Title
*
Mr
Miss
Ms
Mrs
Dr
Prof
Name
*
First Name
Last Name
Role
*
Day Care Assistant
Night Care Assistant
Domestic/Housekeeping/Laundry Assistant
Cook/ Chef
Kitchen Assistant
Team Leader
Senior Carer
Other
If Other please type below Job role
Hours sought per week
Employment Start Date
*
-
Day
-
Month
Year
Date
Care Home/ Location
Beacon House
Croft Lodge
The White House
Willow House
Windward House
Estuary View
Regional Support centre
Your Personal Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number (mobile number preferred)
*
Format: 00000 000 000.
Marital Status
*
Single
Married
Civil Partnership
Divorced / Separated
Widowed
Date of Birth
*
-
Day
-
Month
Year
Date
National Insurance Number
*
Bank Details
Please complete details below for the bank you would like your wages to be paid in to
Name on Account
*
Sort Code
*
Account Number
*
Bank Name
Bank Address
Do you have a P45 from your previous job?
*
Yes (if yes, please submit this to your manager)
No
Please select the option that applies to you
*
Statement A: This is my first job since 6 April and I have not been receiving taxable jobseeker's allowance or taxable incapacity benefit or a state or occupational pension
Statement B: This is now my only job, but since 6 April, I have had another job, or have received taxable jobseeker's allowance or incapacity benefit. I do not receive a state or occupational pension
Statement C: I have another job or receive a state or occupational pension
Any RQF, QCF, NVQ or other qualifications? If so, please state what qualification and level
Signature
*
Submit
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