Dry Lining Specialist Northern Ireland

New Staff Form

Personal Details Record Form - ROI

Information to be obtained from all new staff and passed on to line manager/supervisor Please ensure all information is completed in full.

Personal Details

Forename(s)

Surname

Preferred Name

Age

Date of Birth

PPS Number

Business Type

Company Number (if applicable)

Work Start Date

Trade

CSR/CSCS/Safe Pass Number

Expiry Date

Marital Status

Contact Details

Address Line 1

Address Line 2

City

EIR Code

Home Phone Number

Mobile Phone Number

Email Address

Emergency Contact Details

Forename(s)

Surname

Relationship to employee

Address Line 1

Address Line 2

City

Postcode

Home Phone Number

Mobile Phone Number

Email Address

Bank Details

Bank Name

Branch

Account Name

Account Number

Sort Code

IBAN Number

BIC Code

Medical History

Are there any medical conditions we should know about in the case of an emergency? If yes, state details.

Circulatory Problems such as Varicose Veins, Thrombosis If yes, state details.

Heart Problems such as Angina, High Blood Pressure, Heart Attack, Cholesterol If yes, state details.

Chest Problems such as asthma-Lung Function Test to be completed If yes, state details.

Diabetes If yes, state details.

Epilepsy or fainting attacks If yes, state details.

Skin disorders If yes, state details.

Any current medication If yes, state details.

Back Trouble, arthritis, rheumatism If yes, state details.

Injury to bones, joints, tendons - including wrist tendons If yes, state details.

Any significant health problems If yes, state details.

Do you smoke? If yes, only allowed within the allotted tea break time (1Hr) as further breaks will be deducted from wages.

Employee / Subcontractor Declaration

By submitting this form, I hereby acknowledge receipt of the Oakleaf Health & Safety Policy and have read and understood its contents. I agree to abide by the rules and regulations set out by Oakleaf and I am aware of my duties and responsibilities as an employee / subcontractor.

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