PMA Starter Checklist Form

Step 1 of 5

We require ALL Agency Workers to provide proofs of Identification, Home Address, National Insurance Number and Eligibility to Work in the UK – together with Criminal Conviction Declaration and Bank / Building Society details. Without evidence of this documentation – you will NOT be able to start your Assignment.
Identification
Please supply ONE of the following:
- Passport
- Birth Certificate
- National Identification Card (EU)
Upload Proof of Identification*

File Type (pdf, jpeg, doc, docs)
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Address
Please supply ONE of the following:
- Driving Licence
- Utility / Council Tax Bill
- Bank Statement
Upload Proof of Address*

File Type (pdf, jpeg, doc, docs)
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National Insurance Number
Please supply ONE of the following:
- National Insurance Card
- Payslip / P60 / P45
- Authorised Letter from HMRC
Upload Proof of National Insurance*

File Type (pdf, jpeg, doc, docs)
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Eligibility to Work in the UK
Are You A UK Citizen?*

YesNo
If No, VISA Type?*
Please State Any Restrictions
VISA Expiry?

DayMonthYear
Right to Work Share Code?
If you are NOT a UK Citizen, please supply ONE of the following:
- VISA / Work Permit
- Certificate of Registration as a British Citizen
- Authorised Letter from HMRC
Upload Proof of Eligibility to Work in the UK*

File Type (pdf, jpeg, doc, docs)
Cancelof
Criminal Conviction Declaration

The Rehabilitation of Offenders Act 1974 states that you are not obliged to describe / disclose details of convictions which are considered to be ‘spent’ under the terms of the Act. You are only required to disclose details regarding ‘unspent’ convictions. Additionally, you are not required to disclose details regarding ‘protected’ offences (offences to which filtering rules apply). Do not declare Fixed Penalty driving offences. For more guidance on ‘spent’, ‘unspent’ or ‘protected’ convictions, please visit www.gov.uk If you apply for any role which is exempt from the Rehabilitation of Offenders Act 1974 – meaning you will be required to disclose any ‘spent’ convictions – we will ask you to complete a separate disclosure form. You will not be required to complete this separate disclosure form if you do not wish to be considered for these types of employment. We may be legally required to inform our client – and your assignment may be terminated – if you fail to disclose a criminal conviction whilst working on assignment with PMA.
Have you been convicted of any criminal offence(s) which is / are not yet ‘spent’ under the Rehabilitation of Offenders Act 1974, OR are you facing any criminal prosecution?*

YesNo
If Yes, Date of Offence(s)?

DayMonthYear
Nature of Offence(s)?
Date of Conviction(s)?

DayMonthYear
Sentence / Court Order(s)?
Prosecution Details?
Bank / Building Society Details

Failure to supply the information required – in part or in full – will result in a delay to your PAYE payments.
Bank / Building Society*
Branch Address

Address Line 1

Address Line 2

Town / CityCounty

PostcodeCountry
Account Name(s)*
i.e. As Name Appears On Bank Card
Account Number*
i.e. 8 Digits Only
Sort Code*
i.e. 6 Digits Only
Building Society Roll No
(if applicable)
Next Step: HMRC Starter Checklist

Step 3 of 5

In order to safeguard our candidates’ wellbeing in the workplace, Paul Mitchell Associates highly recommends that any critical medical information detailed below be shared by you with your line manager, first aider or human resources – so that they may best respond to any medical emergency.
Disclosure
Do you have any injuries and / or medical conditions – past or present – which may affect or inhibit your ability to work?*

YesNo
Accessibility
Please provide details on how we may be able to assist you during the recruitment process – i.e. communication, completing aptitude tests, attending interviews etc. We will endeavor to make adjustments to accommodate any reasonable requests.
Details
Injuries & Health Conditions
Please provide details of any injuries and / or medical conditions – past or present – which may affect or inhibit your ability to work – whether in part or full. These may include – but are not limited to – any allergies, cognitive / physical disorders, diseases, muscular or musculoskeletal, special equipment.
Details
Emergency Contact

I hereby grant Paul Mitchell Associates permission to contact my Emergency Contact in the event of a medical emergency, and to pass on any relevant information to the emergency medical team in attendance.
Emergency Contact Name*

ForenameSurname
Emergency Contact Telephone
i.e. Home Number
Emergency Contact Mobile*
i.e. Direct Number
Relationship With You?*

ParentSpouse / PartnerDependentFriendOther
Next Step: Reference Declaration

Step 5 of 5

GDPR & Privacy Policy
Consent

By ticking "I agree", I hereby grant Paul Mitchell Associates consent to provide recruitment services on my behalf in line with PMA's GDPR & Privacy Policy. Paul Mitchell Associates acknowledges and agrees to process all data in accordance with the Data Protection Act 2018 and the General Data Protection Regulations (effective 25th May 2018). This does not affect your right to be “Forgotten”. To view our GDPR & Privacy Policy notice, visit www.paulmitchellassoc.co.uk/gdpr-privacy-policy/
I have read & agree to the terms & conditions outlined in PMA's GDPR & Privacy Policy notice:*

I agree
Candidate Signature (click & hold to draw signature)*

Clear
Print Name*

ForenameSurname
Date*

DayMonthYear
i.e. Date of Signature
Your Email*

Confirmation Emaili.e. yourname@example.com
Verify That You Are Human*
Should be Empty: