MaleFemalePrefer not to disclose
Date of Birth*
Home Phone Number
Mobile Phone Number
Do you have a driving licence?*
Do you have your own transport?*
Reason for Leaving
Salary on Leaving (£)
Take Reference From Here?*
University, College or School Name
Full TimePart Time
Payment for hours worked will be made weekly in arrears direct into the bank account detailed below. Please ensure the details are correct.
Name of Account Holder
National Insurance Number
Are you eligible to work in the UK?*
What is your nationality?*
What proof have you provided?*
Please upload a copy of your ID (jpp, png or pdf files accepted)*
Please tick the box to agree that your payslip will be sent electronically as an e-payslip to the email provided below. Note: If you do not tick the box to receive your payslip electronically, there will be a admin charge for receiving a printed copy.
Please send my payslips electronically
Email to send payslips to.
Would you be interested in receiving more information on our workplace pension?*
Do any of your beliefs restrict you from working in any particular work environments?*
If answering yes to the previous question, please give details:
Would you be prepared to take a drug or alcohol test? (This is a requirement for some of our clients)*
Are you happy to allow us to provide your data to clients for the purpose of work finding activity?*
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.
I would like to receive alerts from 'Step By Step Recruitment Ltd' about current and up-coming vacancies via the following communications. (Please Tick)*
Please confirm your consent to store details and documents.*
Do you have any current or pending criminal convictions or prosecutions, other than those spent under the Rehabilitation of Offenders Act?*
Have you ever served a custodial sentence?*
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 Telephone Number
Do you have, or have you ever suffered from any of the following (Please tick the appropriate answer and give details in the space provided below):
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
If you have ticked any of the above conditions, you must provide additional details below:
Have you ever had any problems affecting your ability to:
Stand or walkUse your handsLiftClimb stairs / work at heightWear safety footwearDrive a motor vehicle
Have you ever been or are you currently registered disabled?*
Do you take any regular medication?*
Do you have any allergies?*
Have you ever been dismissed or refused employment for health reasons?*
Have you ever been absent from work for over 3 months due to sickness or injury?*
Have you ever been absent from work for more than 10 days due to a medical reason?*
Have you ever received compensation for an injury or illness sustained at work?*
Do you or any of your blood relations suffer from any hereditary disease including heart disease and asthma?*
Does any of your close family suffer from any serious health problems?*
Do you have any medical condition affecting your ability to sleep?*
Do you have any other health conditions / health problems that may affect your ability to do night work?*
If you have answered Yes to any of the above questions under the 'Additional Information' Heading, you must provide additional details below:
Please state your weekly Alcohol intake (Units)*
Please state your weekly Tobacco / Cigarette intake*
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.
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.
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.
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.