Your Details

    About You

    MaleFemalePrefer not to disclose


    Contact Information

    Next of Kin


    YesNo CarBikeNo

    Employment History

    About the Company

    Your Role

    Supervisor Details


    Academic Education & Qualifications

    Vacancy Preferences

    Full TimePart Time Days/LatesNights TemporaryPermanent YesNo

    Payment Details

    Payment for hours worked will be made weekly in arrears direct into the bank account detailed below. Please ensure the details are correct.

    - -

    Further Details

    Nationality & Eligibility to Work in the UK


    Pay Slips

    Please send my payslips electronically




    YesNo YesNo YesNo

    Stay Connected - GDPR

    The law has changed and to ensure you still receive information from us about job vacancies you will need to opt in to the below methods of communcation. There will be some circumstances where we will be able to contact you without an opt in but these will be limited.

    TelephoneSMSEmail YesNo

    Criminal Convictions

    YesNo YesNo

    Medical Fitness

    It is your right under the Working Time Regulations 1998 to have a health assessment whilst you are a night worker and at regular intervals thereafter. This questionnaire will be used to assess if you have any condition which may affect your ability to do night work only. Any medical details you give are confidential.

    Doctor's Details

    Your Health

    Headaches or migrainesStomach ulcerMental illnessFits / Epilepsy / BlackoutsBack troubleAnxiety or depressionFainting or dizzy spellsJoint complaints or arthritisChest diseaseSwollen anklesBreathing problemsVaricose veinsAsthmaAbnormal blood pressureHeart trouble or surgerySkin complaints / dermatitisAbdominal problemsImpaired vision / eye troubleBladder, liver or kidney troubleA requirement to wear glassesDiabetesHearing or ear problemsHernia or ruptureA requirement to wear a hearing aid Stand or walkUse your handsLiftClimb stairs / work at heightWear safety footwearDrive a motor vehicle

    Additional Information

    YesNo YesNo YesNo YesNo YesNo YesNo YesNo YesNo YesNo YesNo YesNo

    Please Note: The information provided in this questionnaire is strictly confidential; however, we need your consent to allow us to disclose this information to clients of Step By Step Recruitment Ltd upon request. As a result of the information that you have provided you may be referred to your doctor for a medical fitness certificate before Step By Step Recruitment Ltd can offer you certain work placements.

    Failure to disclose any information regarding your fitness, or making false declarations, may result in Step By Step Recruitment Ltd having to terminate your contract.

    Declaration: I hereby certify that I have answered all of the above questions truthfully and to the best of my knowledge. I know of no reason that I am medically unfit for work. I hereby give my consent to the information provided being disclosed to clients of Step By Step Recruitment Ltd where requested.

    Agreements and Contact Methods

    Working Time Directive - 48 Hour Maximum Working Week

    This agreement is made between Step By Step Recruitment Ltd and the Worker.

    Agreement: The Working Time Regulations 1998 provide that the average working week, including overtime, shall not exceed 48 hours. By signing this agreement the Company and the Worker agree that the limit to working hours shall not apply to the Worker. This agreement will remain in force indefinitely or until such time as the Company or the Worker terminate the agreement. Written notification must be given to terminate this agreement.

    Terms of Assignment

    Please read the Terms of Assignment (opens in new tab)

    I have read, understand and agree these standard Terms of Assignment in the link above and agree to my name being included on Step By Step’ register of people who may be contacted for assignments, and that my details may be forwarded to Clients.

    Final Declaration and Agreement

    Agreement: I hereby certify that the information I have provided in this document is true and to the best of my knowledge. I authorise Step By Step Recruitment Ltd to use any or all of this information in conjunction with my application for work placements.