REACHOUT REG FORM 2021

Registration and Induction
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (don't write in the 0)
Please enter a valid phone number.
Email
example@example.com
Date of Birth*

MonthDayYear
Date
Nationality
UTR No
National Insurance Number
Next of Kin to be notified in case of emergency

First NameLast Name
Phone Number (don't put in the 0)
Please enter a valid phone number.
Email Address
example@example.com

Rows	Yes	No
Do you Smoke
Do you have a valid driving licence
Do you have your own vehicle
Are you prepared to work at heights
Have you ever worked with asbestos or in the asbestos industry
Have you filed any workers compensation claims

CSCS Card Colour & No
Date

MonthDayYear
Date
CCDO Card Colour & No
Date

MonthDayYear
Date
CPCS Card Colour & No
Date

MonthDayYear
Date
Any other cards
Date

MonthDayYear
Date
Please provide information to education, vocational training and qualifications. eg NVQ, city & guilds, apprenticeships etc:
Summarise previous positions and practical skills acquired:
Company
Reference Name
Position
Phone Number (don't put in the 0)
Please enter a valid phone number.
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Type of work and duties:
Company
Reference Name
Position
Phone Number (don't put in the 0)
Please enter a valid phone number.
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Type of work duties:
Identification Verification

RIGHT TO WORK IN THE UK
Do you have the right to work in the UK*

YesNo
Do you have the 'right to work' Share Code Number

YesNo
Please click on the following link to generate share code:

https://www.gov.uk/prove-right-to-work

Right click to open in new tab.
Upload files, copy of ID, tickets, share code, NINO etc

Cancelof
Share Code Number
What documentation have you provided, as proof of right to work in the UK?*

Current UK PassportNon UK Passport + VisaBirth CertificateResidence PermitSpouse VisaPre-settlement confirmation from HMRC
Is there a restriction on the length of time you can work in the UK?

YesNo
If Yes, please state end date you can work to

MonthDayYear
Date
Have you ever been convicted of a criminal offence? (NB. The Rehabilitation of Offenders Act 1974)

YesNo
If Yes, please give details below:
You may be offered an opportunity to work within an environment or establishment where you come into contact with children or other vulnerable groups, or your professional occupation may fall within certain expected categories where this is likely to apply, the Rehabilitation of Offenders Act 1974 (exceptions) order 1975 requires us to ask you for additional information. A criminal check from the Criminal Records Bureau may be required when this type of work is sought. Do you have any previous convictions, whether or not they are spent within the Act, including any cautions, reprimands, final warnings, bind-overs or any convictions from overseas.

YesNo
If Yes, please give details below:
Do you hold a criminal record bureau disclosure or overseas police check carried out within the last 3 years?

YesNo
If Yes, please give details below:
Do you hold any form of current Security Clearance?

YesNo
If Yes, please give details below:
Bank Account Details:

We collect bank details, in the strict confidence that they will not be used or passed on to a third party company outside of your permission. They will only be submitted to payroll companies once we have found you a job. Reachout Recruit work with FCSA accredited payroll companies.
Name of bank:
Account Name:
Account Number:
Sort Code:
Reachout Recruit Policies, which must be read and acknowledged.
I certify that the foregoing particulars are correct and accept that previous employers may be contacted for a reference. I understand that if any information i have given or give in the future, regarding statements of skill, experience and employment, if false or misleading may result in termination of the agreement. The company reserves the right to keep personal information on all registrations and provides such information only in a need to know basis. I consent that information given here may be used from time to time for H&S and security or statistical purposes, or to comply with CDM Regulations and other statutory requirements. By accepting an offer to work, i agree to the company retaining suh information, which can include health and sickness information, ethnic origin, trade union memberships and disciplinary matters. I Can request access to my records once a year and, if necessary, require corrections should details be faulty.

I am willing to produce if required, at my own expense a statement by a qualified Medical Practitioner confirming that i am fit to work in the construction industry. I agree to undergo a medical examination at any time at the request of the Company (at its expense) by my own doctor or by a Medical Practitioner appointed by the company. If your medical circumstances change, you must inform the company.
- I understand that smoking is prohibited in all areas of the site.
- I understand that being under the influence of drugs and alcohol is forbidden at all times.
- I understand that personal mobile phones can only be used at break times.
- I have read and understood the company hours of work policy and will inform Reachout Recruit if i intend to work outside this policy.
I accept and agree that there may be periods when no work is available and there is no obligationon Reachout Recruit to find work for me or for me to accept work offered. I have openly disclosed that i am registered with other agents and accept other work from time to time. If at any time i take on additional work outside of my agreement with Reachout Recruit that would result in breaching the working rule agreement, i will inform Reachout Recruit immediately.
To view Reachout Recruit policies please click on the link below:

GDPR

Anti-Bribery & Corruption

Modern Slavery

Right To Work

Equal Opportunities & Diversity

Environmental

Health & Safety

Corporate & Social Responsibility

Drug & Alcohol

Corporate Criminal Offence

Mental Health

Policy*

Rows	Read & Acknowledged
Health & Safety
Drug & Alcohol
Right to Work
GDPR
Modern Slavery
Corporate Criminal Offence

Policy*

Rows	Read & Acknowledged
Environmental
Corporate & Social Responsibility
Bribery & Corruption
Equal Opportunities & Diversity
Mental Health

Data Protection, Declaration & Agreement of Undertaking
Date*

MonthDayYear
Date
Signature*

Clear
Name*

First NameLast Name
Occupational Health Assessment
Occupational Exposure, Have you ever been exposed to or worked with, the following hazards?

ChemicalsDusts (asbestos, silicon etc)Extreme temperatures / radiationGases, fumes, vapoursGrease / oilsLead
Occupational Exposure, Have you ever been exposed to or worked with, the following hazards?

Manual HandlingNoiseSolventsTar, bitumen, asphaltVibrationConfined Spaces
Have you ever had, or been diagnosed with, any of the following occupationally - related medical conditions?

Back / joint disorderDermatitis / skin conditionsHand-Arm Vibration Syndrome (white finger)Carpal Tunnel SyndromeNoise - induced hearing loss
Have you ever had, or been diagnosed with, any of the following occupationally - related medical conditions?

Occupational lung diseaseSignificant injuryWork related upper limb disordersother
If you have ticked any of the above, please provide date of diagnosis and details below:

Medical History

Rows	Yes	No
Are you in good health?
Are you registered disabled?
Are you receiving / have you recently received any form of medical treatment?
Do you suffer from any form of disability?
Are you taking any regular medication?
Have you been absent from work for any medical reason for 10 days or more in the past 24 months?
Been retired early on the grounds of ill health?
Required health surveillance because of your job?
Been advised not to undertake night or shift work?
Had to notify the Vehicle Licensing Centre of a medical condition?
Do you smoke? if so indicate number per day?
Do you drink alcohol? How many units per week?
Do you wear glasses / contact lenses
Do you suffer with defective vision
Do you suffer from any other medical condition which may affect fitness at work?

if answered yes, to any other medical condition, please write details below:

Medical History / Tested

Rows	Yes	No
High blood pressure
Angina
Heart attacks
Poor circulation
Chest Lung complaints
Hearing / balance problems
Back, neck or arm pain
Rheumatism / arthritis
Kidney / bladder problems
Speech / writing problems
Diabetes
Addiction to drugs / alcohol
Recurrent numbness and tingling of hands and / or fingers

Medical History / Tested

Rows	Yes	No
Skin complaints
Sleep disorders
Serious head injuries
Stomach problems
Liver / bowel problems
Blood disorders
Hepatitis B
Epilepsy, fits or blackouts
Mental / psychological illness
headaches / migraines
Visual problems
Asthma
Any other significant medical problem

Vibration (HAVS)

Rows	Yes	No
Have you ever been told that you suffer from Hand-Arm Vibration Syndrome (Vibration White Finger) or a similar condition?
Do you use or have used vibrating tools in your job role?
Do your fingers go white on exposure to cold?
have you had any tingling of the fingers after using vibrating equipment?
Have you had any tingling of the fingers at any other times?
Have one or more of your fingers ever gone numb?
Are you experiencing any problems with the muscles or joints of the hands or arms?
Do you have any difficulty picking up very small objects (such as paperclips) or doing up / undoing your shirt buttons?

If answered yes to any of the above, please write more detail below:
Mental Health Awareness

We understand that anyone suffering from mental health should not be alone. We are keen to promote health and welbeing of workers in the constructiuon industry and therefore recommend anyone who feels they cannot speak to anyone to reach out to Lighthouse. The Lighthouse Charity are passionate about addressing mental health concerns in the construction industry, and in confidence will provide support and strength to each individual worker.

To speak to an expert advisor, please call their freephone number 24/7 - 0345 605 1956.
https://www.constructionindustryhelpline.com/
Doctors / GP details:

Rows Yes No

Are you registered with a GP
GP's Name
GP's Phone Number
Please enter a valid phone number.
GP's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Declaration
I declare that the information i have provided regarding my health is true to the best of my knowledge. I understand that if it is shown i have knowingly withheld medical information, or given misleading or false information, i may be in breach of my employment contract. I also give permission for information to be disclosed to the company by the doctor that is relevant to my health and safety (and or the health and safety of others).
Name*
Date*

MonthDayYear
Date
Signature*

Clear
Working time Regulations
This statement is issued by Reachout Recruit Ltd, 47-50 Margaret Street, London, W1W 8SD in Accordance with the Employment Rights Act 1996. You will notified in writing within one month of any change.

Working Time Regulations 1998

Agreement to Exclude the Maximum Weekly Working Time Limit

Restrictions

The Working Time Regulations 1998 (as amended), effective from 01 October 1998, state that the Temporary workers average working time shall not exceed 48 hours per week on avergae over a 17 week period (or other reference periood as agreed), unless the worker agrees in writing that the limit shall not apply in his /her case.

Consent

The Temporary worker hasa indicated an agreement to work in excess of an average of 48 hours per week.

The company is required to retain this form to allow for inspection by the enforcing authority.

The Law

These Terms are governed by the law of England & Wales and are subject to the exclusive jurisdiction of the Courts of England & Wales.

GDPR

Consent

The GDPR is Europe's new framework for data protection laws - it replaces the previous 1995 data protection directive, which current UK law is based upon. The General Data Protection Regulation (GDPR) (EU) 2016/679 is a regulation in EU law on data protection and privacy for all individuals within the European Union. It also addresses the export of personal date outside the EU.

Declaration

I agree to work when necessary, in excess of 48 hours per week. I understand that i may terminate this agreement at any time subject to giving 7 days notice in writing. I also agree to Reachout Recruit's GDPR policy which i read upon registering.
Name of Temporary Worker*
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Registration and Induction

Summarise previous positions and practical skills acquired:

Identification Verification

Bank Account Details:

Reachout Recruit Policies, which must be read and acknowledged.

Data Protection, Declaration & Agreement of Undertaking

Occupational Health Assessment

Declaration

Working time Regulations