Remity Staffing - Non Clinical Application Form Remity Staffing: Application form for Non clinical Staff Title* First* Last* Address Line 1* Address Line 2* City* Postal/Zip Code* Country* Tel Home NI Number* Mobile* Email* Nationality & Visa Type* DOB* COVID VACCINATIONS YesNo JAB 1 Date JAB 2 Date DRIVING LICENCE YesNo CAR OWNER YesNo DO YOU OWN SAFETY WEAR YesNo UNSPENT CRIMINAL CONVICTIONS/CASES PENDING YesNo IF ANY CONVICTIONS, PLEASE LIST HERE? HOW DID YOU HEAR ABOUT US PREFERRED LOCATIONS FOR WORK ARE YOU A STUDENT YesNo REGISTERED or TEMPED WITH US BEFORE? YesNo Flu Vaccination Declaration (Have you received your Flu jab within last 12 months) YesNo Date Vaccination taken If you have not taken Flu vaccination please explain reason. Next of Kin or Emergency Contact Name* Next of Kin or Emergency Contact Mobile Number* Next of Kin or Emergency Contact Relationship with you* YOU CONFIRM: You Have Received Our Worker's Handbook Which Details Our Service To You. Information Provided Is Correct & In Particular You Have The Qualifications & Abilities You Have Detailed. You Are Happy For Us To Share Your Details With Clients To Secure Work And With Framework Authorised Auditord For Compliance. You Are Happy For Us To Contact Your Previous Employers To Seek References. You Confirm To Work More Than 48 Hours In A Week If Require. Your Are Happy For Us To Conduct A Dbs Check If Required By The Client For Any Position. You Confirm That Received Nisi Handbook And Understood It Signature* DrawType Date* REFERENCES REFERENCE 1 FULL NAME Organisation Email Tel Period Worked Your Role REFERENCE 2 FULL NAME Organisation Email Tel Period Worked Your Role What do you consider important in a job, and why? What are your strengths in relation to this job role? What kind of people do you find most difficult to work with, and why? What are the problem areas you encounter in your present job? If any Are there any on going health issues which we should be aware of? Any special requirements you may need from the employer?