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There are just a few final bits of information we need from you. Only completing both stages of this process confirms your registration with us.

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Step 1 of 16 - Availability

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Name(Required)

First Last

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Job title

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National Insurance number

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Gender

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Ethnicity

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Date of birth

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New starter declaration

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Where did you hear about us

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Phone / Mobile

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Street address

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City

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County

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Postcode

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Country

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Bank Account Name

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Account Number

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Sort Code

Availability

Which areas can you work in?(Required)

Can you work full time, part-time, or both?(Required)

Can you work days, nights, or weekends?(Required)

Do you have your own transport?(Required)

What date are you available from?(Required)

Right to work

Nationality(Required)

Identification document provided(Required)

I can confirm I'm eligible to live and work in the UK(Required)

Yes

If you are a NON-UK candidate, please enter your 9 digit share code (to confirm your status)

Safety wear

Do you have safety boots?(Required)

Do you have hivis?(Required)

As you answered 'no', please give details of sizes required.

Please be aware that you are required to wear safety boots to all of the assignments you are assigned to by Cogent Staffing Ltd.

Additional payroll information

Do you have a P45 or P46?(Required)

P45

P46

Do you have a Student Loan which is not fully repaid?(Required)

Yes

What type of Student Loan do you have?

Plan 1

Plan 2

Are you repaying your Student Loan direct to the Student Loans Company by agreed monthly payments?

Yes

Did you finish your studies before the last 6 April?

Yes

Education - Secondary School

Secondary School Name(Required)

Qualifications and grades achieved(Required)

Start Date(Required)

Finish Date(Required)

Education - Further Education

If you did not undertake Further Education, please leave this section blank, click next, and proceed to Employment History.

Further Education Name

Qualifications and grades achieved

Start Date

Finish Date

Additional qualifications / training

Employment history

Employment history(Required)

Employer's name

Start date

Finish date

Pay rate

Reason for leaving

Duties

Criminal declaration

Do you have any unspent criminal convictions as defined in the Rehabilitation of Offender's Act 1974?(Required)

Yes

The information you give will be treated in confidence and only taken into account where, in the reasonable opinion of Cogent Staffing Ltd, the offence is relevant to the post for which you are applying. A conviction will become spent after a 'rehabilitation period'. Please advise if you need a list of rehabilitation periods.

Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared and later comes to light.

Details of criminal convictions

Disability Discrimination Act

This Act protects people with disabilities from unlawful discrimination.

Do you have any disabilities which we would need to make reasonable adjustments for in the workplace?(Required)

Yes

Please provide details

Health assessment

Completion of this section is required in order to allow Cogent Staffing Ltd to carry out an assessment of your ability to work in environments in which we assign you to and ensure that we assess any conditions which require us to make special arrangments. It also allows us to fulfil our obligation under the Working Time Regulation 1998 with regards to those who may work night shifts.

Do you suffer from or have you suffered from any of the following in the last 12 months?

Chest Pain/Angina(Required)

Yes

Colour Blindness(Required)

Yes

Epilepsy(Required)

Yes

Severe Stomach Disorders(Required)

Yes

Sleeping Disorders(Required)

Yes

Diabetes(Required)

Yes

Allergies(Required)

Yes

Heart Problems(Required)

Yes

Circulation Problems(Required)

Yes

High Blood Pressue(Required)

Yes

Asthma/Bronchitis/Pneumonia(Required)

Yes

Medical Problems made worse by working at night(Required)

Yes

Are you on medication?(Required)

Yes

Medical Problems made worse by working at night(Required)

Yes

If you have answered yes to the above Health questions, please give further details:(Required)

Have you ever worked in a chilled warehouse environment before?(Required)

Yes

Have you ever worked in a freezer / extreme cold environment before?(Required)

Yes

Declaration(Required)

The information I have given above is true to the best of my knowledge and I have not knowingly omitted anything that could impair my working performance. I authorise Cogent Staffing to share my Health Assessment information with relevant 3rd parties including Hiring Managers at companies I start placements with.

Next of Kin

Please provide contact details for a next of kin in case of an emergency.

Name(Required)

First Last

Relationship to you(Required)

Mobile phone number(Required)

Home phone number

References

Please provide us with professional references from your former managers or coworkers.

Name(Required)

First Last

Company(Required)

Position(Required)

Contact number(Required)

Would you like to submit a second reference?(Required)

Yes

Second Reference

Name(Required)

First Last

Company(Required)

Contact number(Required)

Position(Required)

Would you like to submit a third reference?(Required)

Yes

Third Reference

Name(Required)

First Last

Company(Required)

Contact number(Required)

Position(Required)

Terms of engagement and other documentation

Please view our Terms of Engagement
Please view our Holiday Statement and 48 Hour Opt Out Agreement

Please sign here to confirm you have read and agree with the above documents.(Required)

Employee declaration

Declaration 1(Required)

I understand, and give my consent, that from time to time, application documents, ID verification, references, work history or any other information pertaining to vetting may be viewed by a senior member of Cogent Staffing Ltd and any other person or body that requests disclosure of this material to ensure Cogent performs its business in line with Home Office regulation and to clients' expected standards. This includes 3rd party organisations such as GRI, Neuven and any other external company who may request your data and personal information in order to carry out worker audits.

Declaration 2(Required)

I hereby authorise Cogent Staffing Ltd to disclose such information upon request.

Declaration 3(Required)

I declare to the best of my knowledge that all the information contained in the application is correct and I authorise Cogent Staffing to contact previous employers for a reference.

Consent

I agree to the Terms and Conditions(Required)

Yes

I agree with and accept the Cogent Staffing Privacy Policy

You must agree to our Privacy Policy in order for us to process your data. View the Privacy Policy here.

In order to provide you with recruitment, payroll and related services we need to acquire and retain certain information about you as an individual. We will keep this information securely, only using it for the purposes outlined in our Terms and Conditions, and in full compliance with the prevailing data protection legislation. Where necessary, in order for us to complete our service to you - such as ensuring you’re paid for the work you. The full terms of our privacy policy and how we keep and use your personal data is published on our website.

I agree to receive Marketing Communications(Required)

Yes

Why have you selected Cogent Staffing?(Required)

Who recommended Cogent Staffing to you? Please list their name and their relationship to you?(Required)

Did you have to pay for the recommendation?(Required)

How did you get to the agency?(Required)

Who did you come with?(Required)

Signature

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Face to face screening confirmation(Required)

Please tick to confirm you have attended a face to face screening interview in person or online

Please tick below to confirm your face to face screening interview in person or online (video call)(Required)

In person screening

Online (video call) face to face screening

Please sign this document online to confirm that the information you have submitted is accurate.(Required)

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Date signed

MM slash DD slash YYYY

Please be patient. Dependent on your connection speed, this form could take a couple of minutes to submit successfully. Do not refresh the page or click to go back on your browser. Once you press submit, you will be redirected to the Contract of Services agreement.

Phone

This field is for validation purposes and should be left unchanged.

Success! Step one complete

Now complete step two

Availability

Right to work

Safety wear

Additional payroll information

Education - Secondary School

Education - Further Education

Employment history

Criminal declaration

Disability Discrimination Act

Health assessment

Next of Kin

References

Second Reference

Third Reference

Terms of engagement and other documentation

Employee declaration

Consent

Signature

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