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Customer Focus

Your new application

Please fill in all fields as fully as you can to help us process your application quickly.

1 About you


First name

Last name

Home phone

Mobile phone

Address 1

Address 2





Date of birth


Place of birth

N.I. number

Marital status


Available date

Car owner

Clean licence

Next of kin
(Name, phone no.)


(after age 11)

Exams passed

Further education

University / college / further education

Exams passed

Experience and qualifications


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2 Your employment history

Details of most recent job

Company name

Nature of business



Annual salary

Date from

Date until

Reason for leaving

Name of contact
(for reference)

Company address 1

Company address 2




Details of previous job

Company name

Nature of business



Annual salary

Date from

Date until

Reason for leaving

Name of contact
(for reference)

Company address 1

Company address 2




Please list jobs where you have previously worked as a temporary

Company name


Company name


Company name


Company name


Company name


Please indicate special work preferences here


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3 Banking and status


Bank/building society name



Account no.

Sort code

Account name

Other details


Please note: If non-EEC is chosen, a work permit is required


Do you have any unspent criminal convictions, in accordance with the Rehabilitation of Offenders Act 1974?

If yes, please provide further details:




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4 HM Revenue and Customs

Your present circumstances

Read all of the following statements carefully and choose the one that applies to you






Student Loans (advanced in the UK)



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5 48 hour maximum average working week

The Working Time Regulations 1998 provide that the average working week, including overtime, shall not exceed 48 hours. The Company and the Worker agree that this limit shall not apply to the Worker. This Agreement will remain in force indefinitely. The Worker, or the Company, may terminate this Agreement at any time by giving not less than three months' written notice to the other.



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6 Your health

If the answer is 'Yes' to any of the questions on this form, please give full details in the space provided of the dates, duration and outcome of the illness or condition. If we have any concerns about your fitness for work, employment will be subject to satisfactory medical reports.

Have you ever had?

Tuberculosis, asthma, bronchitis or chest problems?

If yes, please give details:

Chest pain, heart condition or raised blood pressure?

If yes, please give details:

Blackouts, fits or attacks of giddiness?

If yes, please give details:

Depression, mental illness or nervous breakdown?

If yes, please give details:

Rheumatism or arthritis?

If yes, please give details:

Back trouble?

If yes, please give details:

Typhoid, paratyphoid or other gland trouble?

If yes, please give details:

Digestive or bowel disease?

If yes, please give details:

Diabetes, thyroid or other gland trouble?

If yes, please give details:

Bladder or kidney trouble?

If yes, please give details:

Dermatitis or skin trouble?

If yes, please give details:

Varicose veins?

If yes, please give details:

Any other accident, operation or illness?

If yes, please give details:

Have you any reason to believe you may be infected with any communicable disease?

If yes, please give details:

Any other current or recent medical condition or treatment which might affect your attendance or performance at work?

If yes, please give details:

Do you intend to work night duties on a regular basis?

If yes, please give details:

Any illness or medical condition that prevented you from attending work on your normal duties or activities for more than one week during the past year?

If yes, please give details:

Any physical or mental impairment which has a substantial and long-term effect on your ability to carry out day to day activities? If yes, please specify any special adjustments required in relation to work.

If yes, please give details:

Do you smoke?

If yes, please give details:

How many units of alcohol do you drink per week?

One unit = 1/2 pint of beer = 1 glass of wine = 1 single whisky


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7 Night workers' health questionnaire

Working time legislation requires that employers offer people who work at night the opportunity of a free health assessment before they start working nights and on a regular basis after that.

This form is designed to meet that requirement and help us to ensure that you remain healthy whilst working at night. It is based on advice issued by the Department for Business Innovation and Skills.

The company will make an assessment of your initial or continuing suitability for night work based on the answers you give to this questionnaire. Where we are uncertain we may ask you to attend an examination by a qualified occupational health practitioner.

Please complete this form to the best of your knowledge and tick the appropriate box(es).

Please note, ticking a box does not necessarily mean you cannot work at night; simply that we may need further information.

How long have you worked nights?

Please choose...

Are you on permanent nights?


Do you suffer from diabetes?


If yes, do you require insulin injections?


Do you suffer from a heart condition or a circulatory (blood, artery or vein) disorder?


If yes, does this affect your physical stamina and your ability to do physical work?


Do you suffer from any stomach or intestinal disorder such as ulcers?


Do you have any condition where the timing of a meal is particularly important?


Do you suffer from any medical condition which affects your sleep?


Do you suffer from a chronic chest disorder (such as asthma) where night-time symptoms are particularly troublesome?


Do you suffer from any medical condition requiring regular medication at strict times e.g. epilepsy or thyroid disease?


Have you had depression, 'stress', nervous disorders, or other mental illness, alcohol or drug addiction, in the last two years?


Are you aware of any other health factors that may affect your fitness to carry out night work or do you feel night shifts affect your health in any way?

Additional comments (particularly if you have ticked any boxes above)


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8 Supporting documents

Please upload the following documents as applicable

You can scan documents into PDF or JPG format. The total size of all the files you upload must be no more than 8MB at a time. If any of your documents are larger than this, please re-scan them at a lower quality.

If the total size of all documents is greater than 8MB please upload them one at a time, clicking the 'Save for later' button after each one.

Proof of identity

This could be your passport or ID card.

Passport cover

If you're providing a scan of your passport, please provide a scan of the cover too.

Driving licence - front

Driving licence - back

CPC card - front

CPC card - back

Proof of address 1

This could be a utility bill or bank statement.

Proof of address 2

This could be a utility bill or bank statement.

Proof of national insurance no.

This could be your National Insurance card, a payslip, P60 or P45.


Please scan the front of your Digicard, if you have one.


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9 Terms and conditions

Terms of engagement of temporary workers

BETWEEN A1 DIRECT RECRUITMENT LIMITED acting as an employment business (hereinafter called the "Contractor") AND OPERATOR (hereinafter called the "Temporary Worker")

1. The Contract

a) These terms constitute a contract for services between the Contractor and the Temporary Worker and they govern all Assignments undertaken by the Temporary Worker. However, no contract shall exist between the Contractor and the Temporary Worker between Assignments,

b) For the avoidance of doubts, these Terms shall not give rise to a contract of employment between the Contractor and the Temporary Worker. The Temporary Worker is engaged as a selfemployed worker, although the Contractor is required to make statutory deductions from his remuneration with Clause 3a.

c) No variation or alteration of these Terms shall be valid unless approved by the Contractor in writing.

2. Assignments

a) The Contractor will endeavour to obtain suitable Assignments for the Temporary Worker to work within the Commercial sectors of business within their skill level.

b) The Temporary Worker acknowledges that the nature of the temporary work means that there may be periods when no suitable work is available and agrees: that suitability shall be determined solely by the Contractor; and that the Contractor shall incur no liability to the Temporary Worker should it fail to offer opportunities to work in the above category or any other category.

c) For the purpose of calculating the average number of weekly hours worked by the Temporary Worker on an Assignment, the start date for the relevant averaging period under the Working Time Regulations shall be the date on which the Temporary Worker commences the first Assignment.

3. Remuneration

a) The Contractor shall pay to the Temporary Worker a minimum hourly rate that will not be less than the minimum wage in force from time to time.The actual rate will be notified on a per Assignment basis for each hour worked during an Assignment (to the nearest quarter hour) to be paid weekly in arrears, subject to deductions in respect of PAYE class, National Insurance Contributions and Income Tax pursuant to S134 of the Income and Corporation Taxes Act 1988 and any other deductions which the Contractor may be required by law to make.

b) Subject to any statutory entitlement under the relevant legislation, the Temporary Worker is not entitled to receive payments from the Contractor or Clients for time not spent on the Assignment, whether in respect of holidays, illness or absence for any other reason unlessotherwise agreed.

c)The contractor will pay the worker in respect of work done by him, whether or not if the contractor has been paid by the hirer in respect of that work.

*4. Statutory Leave

a) For the purposes of calculating entitlement to leave under this clause, the leave year commences on the date the Temporary Worker starts an Assignment or a series of Assignments which last for a continuous period of one month or more.

b) Under the Working Time Regulation 1998, the Temporary Worker is entitled to 28 days paid leave per year pro rata. All entitlement to leave must be taken during the course of the year and none may be carried forward to the next year.

c) The right to paid leave only accrues once the Temporary Worker has been engaged on Assignments through the Contractor for a continuous period of one month. After that time, entitlement to leave accrues in proportion to the amount of time worked continuously by the Temporary Worker on Assignment during the leave year.The amount of payment to which the Temporary Worker is entitled in respect of such leave is calculated in accordance with and in proportion to the number of standard hours that he works on Assignments.

d) Where the Temporary Worker wishes to take any leave to which he is entitled, he should notify the Contractor in writing of the dates of his intended absence.The amount of notice the Temporary Worker is required to give should be at least twice the length of the period of leave that he wishes to take. Unless the Contractor informs the Temporary Worker in writing that it is not possible for him to take leave on the specified dates, the Temporary Worker shall be entitles to take up his notified leave entitlement.

e) The Contractors may at his discretion require the Temporary Worker by upon one week's notice to take Bank holiday or any other public holiday as part of his paid annual leave entitlement if such days fall during an Assignment.

f) None of the provisions of this clause regarding the statutory entitlement to paid leave shall affect the Temporary Worker's status as a self-employed worker.

*Under a European Court of Justice ruling, all workers employed in the road transport sector, even non-mobile office workers, are excluded form the Working Time Regulations and are therefore not entitled to receive holiday pay.

5. Sickness Absence

a) The Temporary Worker may be eligible for Statutory Sick Pay provided he meets the relevant statutory criteria.

6. Time Sheets

a) At the end of each week of an Assignment (or at the end of the Assignment where it is for a period of one week or less or is completed before the end of the week) the Temporary Worker shall deliver to the Contractor his time sheet duly completed to indicate the number of hours worked by him during the preceding week (or such lesser period) and signed by an authorized representative of the Client. Failure to submit a time sheet for the hours worked may delay payment for those hours.

b) For the avoidance of doubt and for the purposes of the working Time Regulations, the Temporary Worker's working time shall only consist of those periods during which he is carrying out his activities or duties for the Company as part of the Assignment. Time spent travelling to the Company's premises, lunch breaks and other rest breaks shall not count as part of the Temporary Worker's working time for these purposes.

7. Conduct of Assignments

a) The Temporary Worker is not obliged to accept any Assignment offered by the Contractor but if he does so, during every Assignment and afterwards where appropriate he will:-

i) co-operate with the Client's staff and accept direction, supervision and control of any reasonable person in the Client's organisation;

ii) observe any relevant rules and regulations of the Client's establishment to which attention has been drawn or which the Temporary Worker might reasonably be expected to ascertain;

iii) unless arrangements have been made to the contrary, conform to the normal hours of work in force at the Client's establishment;

iv) take all reasonable steps to safeguard his own and the safety of any other person who may be present or affected by his actions on the Assignment and comply with health and safety policies of the Client

v) not engage in any conduct detrimental to the interests of the Client

vi) not at any time divulge to any person, nor use for his own or any other persons benefit any confidential information relating to the Client's or Contractor's employees, business affairs,transactions or finances.

b) If the Temporary Worker is unable for any reason to attend work during an Assignment he should inform the Client or Contractor by no late than 30 minutes before the commencement of work on the first day of absence to enable alternative arrangements to be made.

8. Termination

a) The Contractor or client may, without prior notice or liability, instruct the Temporary Worker to end an Assignment at any time

b) The Temporary Worker may terminate an Assignment at any time by informing the Contractor

9. Restrictions

a) The Working Time Regulation 1998 provide that the Temporary Worker shall not work on an Assignment with the Client in excess of an average of 48 hours each week calculated over a 17 week reference period (the Working Week) unless he agrees in writing that this limit should not apply

10. Consent

a) The Temporary Worker hereby agrees that the Working Week limit shall not apply to the Assignment

11. Withdrawal of Consent

a) The Temporary Worker may end this Agreement by giving the Contractor 2 weeks notice in writing

b) For the avoidance of doubt, any notice bringing this Agreement to an end shall not be construed as termination by the Temporary Worker of an Assignment with a Client

c) Upon expiry of the notice period set out in Clause 11a) the Working Week limit shall apply with immediate effect.

These Terms are governed by English Law and are subject to the exclusive jurisdiction of the English Courts.

Data protection:
I consent to my personal information being used solely by A1 Direct Recruitment for the purposes of this job application, and, if my application is unsuccessful, it subsequently being held on file for a period of 6 months, should any other suitable vacancies arise in that time, which we may contact you about.

You agree to the terms above

You confirm that you have answered all questions honestly and fully

Your email address

The date of your application (today's date)

Leave blank:


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