Romax Registration

Form
Please enter your Profession / Trade*
Name*

First NameLast Name
D.O.B*

DayMonthYear
Date
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
National Insurance Number*
RIGHT TO WORK
Right to work in the UK*

YesNo
British Citizen*

YesNo
Enter Nationality*
All candidates without a British citizenship must apply for UK Settlement. Please state the code that will need to be shared with your employer (must have been issued within the last 30 days or you will need to reapply for another code). Code
Code
PAYMENT DETAILS
Account Number*
Sort Code*
Name on Bank Account*
Name of Bank*
Are you CIS Registered*

YesNo
Please supply your UTR Number*
EMERGENCY CONTACT DETAILS
Name*

First NameLast Name
Phone Number*
Relationship*
WORK HISTORY
Please provide us with your last 3 work placements along with details of the person we can contact for a reference
First placement
Company Name
Job Title
Dates Worked
Reason For Leaving
Referees Name
Referee Job Title
Referee Phone Number
Referee Email
example@example.com
Second placement
Company Name
Job Title
Dates Worked
Reason For Leaving
Referees Name
Referee Job Title
Referee Phone Number
Referee Email
example@example.com
Third placement
Company Name
Job Title
Dates Worked
Reason For Leaving
Referees Name
Referee Job Title
Referee Phone Number
Referee Email
example@example.com
EQUAL OPPORTUNITIES
Romax Solutions is committed to a policy of equal opportunities for all work seekers and shall always adhere to such a policy and will review on an on-going basis on all aspects of recruitment to avoid unlawful or undesirable discrimination. We will treat everyone equally irrespective of sex, sexual orientation, gender reassignment, marital or civil partnership status, age, disability, colour, race, nationality, ethnic or national origin, religion or belief, political beliefs or membership or non-membership of a trade union and we place an obligation upon all staff to respect and act in accordance with the policy. Romax Solutions shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment, or in any terms of employment or terms of engagement for temporary workers. Romax Solutions will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualification, and ability to perform the relevant duties required by the vacancy.
HEALTH & DISABILITY
Have you got any underline medical conditions or disabilities that may impact your ability to work?*

YesNo
Are you taking any medication that may affect your ability to work?*

YesNo
If yes please specify
Have you passed a fit for work certificate / Safety critical medical to work on site?*

YesNo
CRIMINAL RECORD DISCLOSURE
Before completing this section please read our policy regarding candidates with criminal convictions. We are asking you to complete this form in relation to job roles which are not exempt from the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020). For this reason you are only required to disclose information about unspent convictions. You are not required to disclose spent convictions on this form. Additionally, you are not required to declare any information about ‘protected’ offences – (offences to which the filtering rules apply). If you are unsure as to whether a conviction is unspent/spent or protected (filtered) please see the additional guidance or you can contact organisations such as NACRO or Unlock for further information If you wish to be put forward for/if any role is identified which may be suitable for you but which is exempt from the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020), meaning that you are required to disclose spent convictions, we will ask you to complete an additional criminal disclosure form. You are not required to complete that additional form if you do not wish to be put forward for that type of work.
Do you have any unspent criminal convictions?*

YesNo
If yes, please provide the offence dates, dates of conviction/caution, offence types and sentences above.
If you have declared any convictions, you are welcome to provide us with any additional information that you think may be relevant and which will help us to determine your suitability to be put forward for roles with our clients. This could include for example information about the circumstances of the offence, any work (paid or voluntary) or training that you have undertaken since, change in your circumstances etc. We will seek to put forward/supply the best possible candidates to our clients. Having a criminal conviction will not necessarily exclude you from the process. The information given will be treated in the strictest of confidence and only taken into account where, in our reasonable opinion, the offence is relevant to the post to which you are applying. Failure to declare a conviction may require us to exclude you from our register if the offence is not declared but later comes to light. If you are working in an assignment with a client at the moment.
DATA PROTECTION STATEMENT
Romax Site Services Ltd provides work-finding services to its clients and work-seekers. We must process personal data (including sensitive personal data) so that we can provide these services – in doing so, we act as a data controller. This is why we have asked for your personal data on this form. When we process your personal data we must do so in accordance with data protection laws. Those laws require us to give you a Privacy Statement on our website to explain how we manage your personal data.
Name*

First NameLast Name
Date*

DayMonthYear
Date
Signature

Powered by Jotform SignClear
Please tick to confirm you have read and agree to our Terms & Conditions*
Terms & Conditions
Should be Empty:

Form

RIGHT TO WORK

PAYMENT DETAILS

EMERGENCY CONTACT DETAILS

WORK HISTORY

First placement

Second placement

Third placement

EQUAL OPPORTUNITIES

HEALTH & DISABILITY

CRIMINAL RECORD DISCLOSURE

DATA PROTECTION STATEMENT