Online registration form - Bluestones Supply Chain

Online registration.

Step 1 of 21 - Application for employment

Application for employment

What sector are you applying for?(Required)

What office are you applying via?(Required)

Please note, this means the office which is managing the vacancy not the geographical location of the vacancy. If you are unsure, please view the vacancy on the Bluestones Supply Chain website to see which office is managing it.

Name(Required)

First Last

Position required

This field is hidden when viewing the form

Date(Required)

Day

Month

Year

I hereby confirm that I have approached Bluestones Supply Chain Ltd of my own free will so that they can assist me in my search for suitable alternative employment.

I confirm that Bluestones Supply Chain Ltd did not contact me or influence my decision in any way.

Please sign here to confirm the above statement is true(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Personal details

Name(Required)

First Last

Date of birth(Required)

Day

Month

Year

Address(Required)

Street Address Address Line 2 City County Post Code

Mobile Phone Number(Required)

Home Phone Number

Email(Required)

Nationality(Required)

Ethnicity(Required)

National Insurance Number(Required)

Banking information

Please note that this information can only be used to pay money into your bank account. It is securely transmitted to Bluestones Supply Chain and will be used to pay you your wages.

Name as it appears on bank account(Required)

Sort Code(Required)

Account Number(Required)

Type of employment required

Please tick which types of employment you are looking for:

7.5t Driver

Clerical

Car or Light Van Driver

Drivers Mate

FLT Driver

HGV 1 Driver

HGV 2 Driver

Production Line/Assembly

Security

Warehouse Picking/Packing

Please tick which locations you are looking for employment in:

London

North West

North East

Yorkshire

West Midlands

East Midlands

East of England

South West

South East

Scotland

Wales

Work History

Employment History(Required)

Employer

Date From

Date To

Reason for leaving

Position Held

Main Duties

Reference Contact Details(Required)

Contact Name

Company Name

Position

Phone Number

Email Address

Skills & Experience

Please select all relevant experience and skills.

* Where marked(*), please ensure that relevant licences are produced and copied.

Driving

7.5 Tonne Driver*

ADR / Hiab*

Draw Bar

Dray

Handballing

HGV 1 Driver*

HGV 2 Driver*

Light Van*

Low Loader

Multi-drop

Nights Out

Rope & Sheet

Skips

Shunting

Tachograph (digi)

Tail Lift / Fridge

Industrial

Clamp Truck*

Drivers / Dray Mate

FTL Counter Balance*

FTL Reach*

Home Delivery Mate

Picking / Packing

Production / Assembly

Clerical

Call Centre

Clerk

Security

Stock Control

Warehouse

Safety wear

Please tick what safety wear you have:

Hi-viz Vest Jacket

Overalls

Safety Footwear

Safety Helmet

Shift preferences

Please tick your preferred shifts:

Afternoons

Days

Nights

Preferred Start Time:

Hours

Minutes

AM/PM

I hereby declare that, to the best of my knowledge, the information in this application is true and correct. I understand that the information supplied is for Bluestones Supply Chain use (and associated companies) and that information may be supplied to third parties. I hereby give Bluestones Supply Chain my consent to approach any or all companies mentioned above to obtain details of my past work history.

Please sign here to confirm the above statement is true:(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Contract for services for the engagement of an agency worker

Between

(1) Bluestones Supply Chain Ltd (“the company”) and

(2) Contractor(Required)

First Last

Click to read our Terms and Conditions.

(T&Cs will open in a new window. The link will also be included in the completed PDF that will be emailed to you once you finish your registration).

I agree to the terms and conditions(Required)

Yes

I agree to receive marketing communications(Required)

Yes

Please sign here to confirm you agree with the above:(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Contract for services for the engagement of an agency worker

This field is hidden when viewing the form

This agreement is made on:

MM slash DD slash YYYY

Between

(1) Bluestones Supply Chain Ltd (“the company”)

and (2) Temporary Worker as set out in the Assignment Schedule: Is is AGREED as follows:

Click to read our Terms and Conditions.

(T&Cs will open in a new window. The link will also be included in the completed PDF that will be emailed to you once you finish your registration).

I agree to the terms and conditions(Required)

Yes

I agree to marketing communications(Required)

Yes

Please sign here to confirm you agree with the above:(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Numeracy and Literacy Test

Arithmetic

15 + 9 =(Required)

97 - 24 =(Required)

27 + 7 + 12 =(Required)

6 x 3 + 2 =(Required)

25 x 4 - 17 =(Required)

100 - 50 x 2 =(Required)

Please complete the following sequences

4 8 12 16 20 24 28(Required)

3 6 9 12 15 18 21 24(Required)

7 14 21 28 35 42 49(Required)

9 18 27 36 45 54 63 72(Required)

Tom went to the supermarket and purchased 3 folders costing £1.86 each. He paid with a £10 note. How much change will Tom get?(Required)

Mark goes to the store and purchases 100 DVDs, they cost Mark 13p each. How much did Mark spend?(Required)

Spelling

1.(Required)

Photograf

Fotograph

Photograph

Photergraph

2.(Required)

Febuary

February

Febuwary

Februarie

3.(Required)

Reciets

Receets

Reciepts

Receipts

4.(Required)

Bisness

Bizeness

Buisness

Business

Product Dispatch Test

Below are some labels for a variety of products

Product Cornflakes Quantity 24 Store Bedford Code 090709	Product Digestives Quantity 60 Store Liverpool Code 011282	Product Cheese Slices Quantity 150 Store Coventry Code 570423	Product Oven Chips Quantity 124 Store Leicester Code 160781
Product Heinz Beans Quantity 48 Store Warwick Code 124642	Product Mars Bar Quantity 248 Store Sunderland Code 291281	Product Budweiser Quantity 36 Store Newcastle Code 097345	Product Bread Quantity 86 Store Manchester Code 021092

The manager needs to update his files and needs you to complete the following information sheet...

What is the product code for oven chips?(Required)

What is being sent to Manchester?(Required)

What product is 090709?(Required)

How many packets of cheese slices are being sent?(Required)

Working Time Test

1. Under EC regulations what is the maximuim number of "shifts" a driver is permitted to work prior to taking a daily rest?

2. What is the maximum driving hours permitted in a week?

3. What is the maximum number of driving hours permitted per fortnight?

100

4. What is the maximum driving period permitted before a break must be taken?

4.5

4.75

5. As an alternative to a 45 min rest period, the rest period can be split into two. How long must the second rest period be (minimium)?

6. What is the normal Daily driving limit?

8.5

7. How many hours can the daily driving limit be extended to?

9.5

8. How many times can this daily driving limit be extended by?

9. How many hours rest should a driver NORMALLY take before starting next shift?

10. Daily rest can be reduced to 9 hours on how many occasions between two weekly rest periods?

11. How many hours is a typical weekly rest period?

12. You can reduce your weekly rest period to what (minimum)?

13. If after 6 hours you have not reached 4.5hours and taken a rest break - how many minutes rest do you need for WTD?

14. In WTD rules what can your average working week be over a 17 week average period?

15. IN WTD what is the maximum hours that can be worked in one week?

Medical Questionnaire

The information supplied below is solely for the use of Bluestones Supply Chain. No details will be passed to any 3rd parties without the express permission (in writing) of the undersigned.

Previous work history

Have you ever been exposed to any of the following in the course of your previous work?

Repetitive movement

Chemicals

Skin irritants

Dusts

Asbestos

Heavy metals

Noise

Lead

Gases

Vibration

Did this exposure affect your health? Please provide more details.

Lifestyle

Height:(Required)

Weight:(Required)

Do you smoke?(Required)

Yes

Do you drink alcohol?(Required)

Yes

How much alcohol do you consume in a week?(Required)

0 - 5 units

5 - 10 units

10 - 15 units

Over 15 units

Disability

Do you consider yourself to have a disability?(Required)

Yes

Are you currently registered as disabled?(Required)

Yes

Please give details of any medical condition or disability that you require any reasonable adjustments that the company could make to enable you to do your job? Please advise what adjustments you would require.

Medical history

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

Any condition(s) that affects your ability to drive(Required)

Yes

Heart problems (angina, heart attack etc)(Required)

Yes

High or low blood pressure(Required)

Yes

Chest problems eg. Bronchitis, Asthma, Emphysema shortness of breath(Required)

Yes

Persistent indigestion, stomach ulcers or diarrhoea(Required)

Yes

Skin conditions e.g. Eczema, Dermatitis, Psoriasis(Required)

Yes

Any dental problems or Tooth/gum infections(Required)

Yes

Fainting attacks, giddiness or blackouts(Required)

Yes

Recurring eye, nose or ear infections(Required)

Yes

Liver disease – Hepatitis or Jaundice(Required)

Yes

Type 1 or 2 Diabetes(Required)

Yes

Epilepsy or fits(Required)

Yes

Mental health condition - Stress, Anxiety, Depression or any other nervous disorder(Required)

Yes

Any condition affecting your joints/musculo-skeletal system – Back, Neck, Hands, Wrists, Elbows, Shoulders, Knees etc(Required)

Yes

Dependency to drugs and/or alcohol(Required)

Yes

Loss of vision/serious defect in either eye(Required)

Yes

Migraines or recurring headaches(Required)

Yes

Hearing difficulties or discharge from either ear(Required)

Yes

Allergies(Required)

Yes

Are you on any medication?(Required)

Yes

If you have answered yes to the above health questions, please give further details:

Do you suffer from, or have you ever received treatment for an allergic reaction to any foods e.g. gluten, nuts, prawns, spices, food additives?(Required)

Yes

If yes, please provide more details.

Do you have a medical condition that would affect you working shifts including nights?(Required)

Yes

Please provide details:

Do you wear glasses/contact lenses or have any other vision abnormalities?(Required)

Yes

Please provide details:

Are you colour blind?(Required)

Yes

Please provide details:

Have you traveled outside of Europe in the previous 3 months?(Required)

Yes

Did you suffer any illness during your trip or since you returned?(Required)

Yes

Please provide details:

Do you consider yourself to be in a good state of health and able to carry out the job for which you are applying in a safe manner?(Required)

Yes

Please provide details:

Do you have any medical problem that has not been mentioned in the previous questions?(Required)

Yes

Please provide details:

Are you currently taking any medication at present either over the counter or prescribed by your Doctor or from a Pharmacy?(Required)

Yes

Please provide details:

Does this medication have to be taken at strict times?(Required)

Yes

Do you require any support with break times at work?(Required)

Yes

Please provide below any further information about your health that we need to be aware of that has not been covered above:

I certify that the answers to the above questions are true and correct to the best of my knowledge. I consent to share this information with line management and HR so that any adjustments or restrictions that may need to apply to my employment based on the information provided can be made/understood. Please sign:(Required)

Declaration of Employee to Decline the Health Assessment Questionnaire for Night Workers

It is your right under the Working Time Regulations (amended 2003) to have regular health assessments whilst a night worker (those who regularly work at least three hours between 11pm and 6am). This questionnaire will be used to assess if you have any conditions which may affect your ability to do night work only. Medical details provided are confidential, but your manager will be advised on whether you are fit/unfit to undertake night work.

Consent(Required)

I understand that under the Working Time Regulations 1998, I am entitled to a night worker health assessment but wish to decline this offer.

Name(Required)

First Last

Date(Required)

DD slash MM slash YYYY

Signature(Required)

Next of Kin

Please provide details of your Next of Kin(Required)

Name

Daytime telephone number

Evening telephone number

Please sign here to confirm the above statement is true:(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

The road transport directive (RTD)

The main provisions of the RTD are;

A 48-hour average working week over a 4 or 6-month reference period (No individual opt-out is allowed).
Up to 60 hours can be worked in one week providing that the 48-hour averages are not exceeded.
Working time is limited to 10 hours in any 24 hour period if any work is carried out at night time. The UK Government has announced that through collective agreement the 10-hour limit can be extended.
Nighttime is defined as between midnight and 04:00 am for workers in the road freight sector and 01.00 am and 05.00 am for workers in the bus and coach sector.
EU Drivers’ Rules require a break of 45 minutes after 4.5 hours of driving. If driving is combined with other work additional break requirements apply. The RTD states a 30-minute break must be taken after 6 hours of consecutive work.

Work Time Regulations and UK Drivers’ Hours Regulations

All mobile workers not covered by the EU drivers’ Hour Rules receive protection under UK Drivers’ Hours regulations and the horizontal Amending Directive which was incorporated into the Working Time Regulations in August 2003.

The Working Time Regulations provided for;

A 48-hour average working week (an individual opt-out is allowed) (This does not include LGV Drivers – this applies to buses etc.)
4 weeks paid annual leave
A requirement for night workers to have regular health checks
The need for adequate rest

Please choose one of the following:(Required)

A) You are solely working for Bluestones Supply Chain Ltd

B) You are working for multiple agencies on various contracts and you will inform Bluestones Supply Chain Ltd of any additional hours worked.

Do you want to opt out of the WTD requirement preventing you from working a maximum of 10 hours if that shift includes work between 12am – 4am?

Yes

Work Time Regulations

Work Time Regulations and UK Drivers’ Hours Regulations

The Working Time Regulations provided for;

A 48-hour average working week (an individual opt-out is allowed) (This does not include LGV Drivers – this applies to buses etc.)
Four weeks paid annual leave
A requirement for night workers to have regular health checks
The need for adequate rest

Please choose one of the following:(Required)

You are solely working for Bluestones Supply Chain Ltd

You are working for multiple agencies on various contracts and you will inform Bluestones Supply Chain Ltd of any additional hours worked.

48 hour opt

1. Definitions

1.1. In this Agreement the following definitions apply:

“Agency Worker” means [name and address of Agency worker] supplied by the Employment Business to provide services to the Hirer;

“Assignment” means the period during which the Agency Worker is supplied to provide services to the Client;

“Client” means the person, firm or corporate body using the services of the Agency Worker;

“Employment Business” means Bluestones Supply Chain Limited (registered company number 09326046) of Unit A Telford Court, Chester Gates Business Park, Chester, United Kingdom, CH1 6LT

2. Restriction

The Working Time Regulations 1998 provide that the Agency Worker shall not work on an Assignment with the Client in excess of the Working Week unless s/he agrees in writing that this limit should not apply.

3. Consent

The Agency Worker hereby agrees that the Working Week limit shall not apply to the Assignment.

4. Withdrawal of Consent

4.1. The Agency Worker may end this Agreement by giving the Employment Business 1 weeks notice in writing.

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

4.3. Upon the expiry of the notice period set out in clause 4.1 the Working Week limit shall apply with immediate effect.

4.4. There is no restriction on the number of times a worker can opt-out and back into this agreement.

5. The Law

This Agreement is governed by the law of England and Wales and is subject to the exclusive jurisdiction of the Courts of England and Wales

Please sign here to confirm you have read and agree with the 48 hour opt out agreement.(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

48 hour opt

1. Definitions

1.1. In this Agreement the following definitions apply:

“Agency Worker” means [name and address of Agency worker] supplied by the Employment Business to provide services to the Hirer;

“Assignment” means the period during which the Agency Worker is supplied to provide services to the Client;

“Client” means the person, firm or corporate body using the services of the Agency Worker;

“Employment Business” means Bluestones Supply Chain Derby Limited (registered company number 09857836) of Unit A Telford Court, Chester Gates Business Park, Chester, United Kingdom, CH1 6LT

2. Restriction

3. Consent

The Agency Worker hereby agrees that the Working Week limit shall not apply to the Assignment.

4. Withdrawal of Consent

4.1. The Agency Worker may end this Agreement by giving the Employment Business 1 weeks notice in writing.

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

4.3. Upon the expiry of the notice period set out in clause 4.1 the Working Week limit shall apply with immediate effect.

4.4. There is no restriction on the number of times a worker can opt-out and back into this agreement.

5. The Law

This Agreement is governed by the law of England and Wales and is subject to the exclusive jurisdiction of the Courts of England and Wales

Please sign here to confirm you have read and agree with the 48 hour opt out agreement.(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Worker seeker declaration

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

All Positions

Do you have any criminal record other than those ‘spent’ under the Rehabilitation of Offenders Act 1974?(Required)

Yes

Do you have any criminal convictions pending?(Required)

Yes

Do you suffer from any physical or mental defect or infirmity that is likely to affect your ability to carry out work in the positions for which you have applied?(Required)

Yes

Do you have any medical conditions or any other reasons which may prevent you from working nights?(Required)

Yes

Why have you selected Bluestones Supply Chain?

Who recommended Bluestones Supply Chain to you? Please list their name and their relationship to you

Did you have to pay for the recommendation?

Yes

How did you get to the agency?

Who did you come with?

Driving Positions

Are you applying for a driving role?

Yes

Do you suffer from diabetes, a heart condition or any other disease that may impair your driving ability?(Required)

Yes

Have you at any point in the last 5 years been convicted of a motoring offence or have any convictions pending?(Required)

Yes

Have you in the last 10 years had your licence suspended?(Required)

Yes

Have you held the relevant class of licence for the positions for which you are applying for at least 2 years?(Required)

Yes

I hereby declare that the information supplied on my Application Documents is true and correct to the best of my knowledge and that any documentation I have supplied with my application has not been falsified or altered in any way from the original document.

I undertake that should any of the information I have supplied change, in any way, that I shall inform Bluestones Supply Chain of this with immediate effect.

I confirm that Bluestones Supply Chain has supplied me with a copy of their contract for services containing an agreed minimum pay rate. Further, I confirm, they have satisfactorily advised me of my duties whilst on assignment and that it is my responsibility to ensure that I follow all procedures to ensure a safe working environment whilst on assignment. I also confirm that I have provided Bluestones Supply Chain with sufficient evidence for them to obtain two years checkable work history on me and that Bluestones Supply Chain has my consent to approach those people named by myself to obtain such details.

Whilst on assignment with Bluestones Supply Chain I agree to be bound by all current legislation relating to the assignments on which I may be placed. Further, whilst Bluestones Supply Chain will update me on occasion that this legislation changes, I understand that it is my responsibility to ensure that I work within the provisions of English Law at all times.

Please sign here to confirm the above statement is true:(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Staff Handbook

Working with and for Bluestones Supply Chain – this is for you to keep

Address: Bluestones Supply Chain, Duart House, 3 Finch Way, Strathclyde Business Park, Bellshill, Glasgow, ML4 3PR

Contact Number: 0141 442 0060 (24 hour number)

What you need to provide us

Full Birth Certificate, Passport, or ID
Card Proof of address dated in last 3 months: Bank Statement, Utility Bill, Council tax bill
Proof of National Insurance: Job centre documentation, NI Letter or Card, Recent p60 or payslip, tax credit documentation

Work Placements

Bluestones Supply Chain will call you with suitable work placements, telling you the hours, address, duties pay, start dates and any other required information. Please do not feel you have to accept the work we offer, however if you do accept an assignment and you are unable to attend please call the 24 hours agency number ideally 1 hour before your shift.

Payment Information

Bluestones Supply Chain will inform you prior to your assignment what the procedures is for recording hours as each client can be different.

Payment will be made each Friday into your account
Payslips will be emailed directly to you on a Friday

Pay Role Queries? General queries?

If you have any problems relating to your hours, payments, missing payslips or any general enquires please call the agency during office hours and we will deal with this for you immediately.

Holiday Requests

To request holiday pay please email bluestonesscconsultants@bluestones-sc.co.uk and put “Holiday request” in the subject line.

This will allow you to request how many holidays you have along with submitting a Holiday request.

1 week’s notice where possible must be provided to process your holiday pay in time.

Holiday Accrual

Bluestones Supply Chain Limited offer 28 days holidays to its workers, accrued in arrears. Holiday year runs from April to March each year.

Your holidays are accrued as follows:

232 working days eligible to accrue holidays (minus weekends and holidays)
28 days / 232 working days = 12.07%

Sickness

If you are unable to attend your shift, you must give 1 hour notice before your start time. You must call the office number 0141 442 0060 ( if out of office hours please press option one)

Grievance procedure

The company gradience policy and procedure can be obtained from Bluestones Supply Chain, Duart House, 3 Finch Way, Strathclyde Business Park, Bellshill, Glasgow, ML4 3PR or email info@bluestones-sc.co.uk

Assignment Text

You will be issued with a confirmation text including the placements full address, shift times, PPE requirements and Manager to report to.

Bluestones Supply Chain’s Policies

To view our policies including, Privacy policy please visit here: https://bluestones-sc.co.uk/policies/

I can confirm I have received this document and am aware that I can request for this to be resent to me at any time by calling 0141 442 0060 or emailing info@bluestones-sc.co.uk

Staff Handbook confirmation(Required)

Please tick here to confirm you have read the Staff Handbook. A copy will also be emailed to you.

Staff Handbook

Working with and for Bluestones Supply Chain – this is for you to keep

Address: Bluestones Supply Chain Derby, Unit 2, Derwent Business Centre, Clarke Street, Derby, DE1 2BU

Contact Number: 01332 913 171 (24-hour number)

What you need to provide us

Full Birth Certificate, Passport, or ID
Card Proof of address dated in last 3 months: Bank Statement, Utility Bill, Council tax bill
Proof of National Insurance: Job centre documentation, NI Letter or Card, Recent p60 or payslip, tax credit documentation

Work Placements

Bluestones Supply Chain Derby will call you with suitable work placements, telling you the hours, address, duties pay, start dates and any other required information. Please do not feel you have to accept the work we offer, however if you do accept an assignment and you are unable to attend please call the 24 hours agency number ideally 1 hour before your shift.

Payment Information

Bluestones Supply Chain Derby will inform you prior to your assignment what the procedures is for recording hours as each client can be different.

Payment will be made each Friday into your account
Payslips will be emailed directly to you on a Friday

Pay Role Queries? General queries?

If you have any problems relating to your hours, payments, missing payslips or any general enquires please call the agency during office hours and we will deal with this for you immediately.

Holiday Requests

To request holiday pay please email info@bluestones-sc.co.uk and put “Holiday request” in the subject line.

This will allow you to request how many holidays you have along with submitting a Holiday request.

1 week’s notice where possible must be provided to process your holiday pay in time.

Holiday Accrual

Bluestones Supply Chain Limited offer 28 days holidays to its workers, accrued in arrears. Holiday year runs from April to March each year.

Your holidays are accrued as follows:

232 working days eligible to accrue holidays (minus weekends and holidays)
28 days / 232 working days = 12.07%

Sickness

If you are unable to attend your shift, you must give 1 hour notice before your start time. You must call the office number 01332 913 171 ( if out of office hours please press option one)

Grievance procedure

The company gradience policy and procedure can be obtained from Bluestones Supply Chain Derby, Unit 2, Derwent Business Centre, Clarke Street, Derby, DE1 2BU or email info@bluestones-sc.co.uk

Assignment Text

You will be issued with a confirmation text including the placements full address, shift times, PPE requirements and Manager to report to.

Bluestones Supply Chain’s Policies

To view our policies including, Privacy policy please visit here: https://bluestones-sc.co.uk/policies/

I can confirm I have received this document and am aware that I can request for this to be resent to me at any time by calling 0141 442 0060 or emailing info@bluestones-sc.co.uk

Staff Handbook confirmation(Required)

Please tick here to confirm you have read the Staff Handbook. A copy will also be emailed to you.

Personal Information Declaration

I acknowledge and understand that in the course of their normal business, from time to time, Bluestones Supply Chain may need to share some of the information supplied to them by myself.

This information will be limited to:

Address / contact details
Right to work documentation
National Insurance number
Photo Identification
Copies of relevant accreditations or licences

I understand that any information sharing will be limited to Bluestones Supply Chain and its client companies and shall not be passed to third party agencies or to anyone other than for securing work for myself and demonstrating my suitability for that work.

Please sign here to confirm the above statement is true:(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Key Information Document

This example pay statement sets out key information about your relationship with us, including details about pay, holiday entitlement and deductions from your pay required by law.

The Employment Agency Standards (EAS) Inspectorate is the government authority responsible for the enforcement of certain agency worker rights. You can raise a concern with them directly on 020 4566 5333 or through the ACAS helpline on 0300 123 1100, Monday to Friday, 8am to 6pm.

Your pay rate will vary per assignment and will be confirmed directly with you, but is at no time less than the National Minimum Wage.

Name of employment business	Bluestones Supply Chain
Type of contract you will be engaged under	Contract for Services
How often you will be paid	Weekly
Minimum rate of pay per hour	National minimum wage
Deductions from your pay required by law	Tax, National Insurance, Pension
Any other deductions or costs from your pay	None
Recruitment fees or fees for goods and services	None
Holiday entitlement	Current statutory leave per annum for full-time employees is the equivalent of 28 days, for part-time employees this is calculated on a pro-rata basis.

Example rate of pay (National Minimum Wage)	£11.44 per hour
Example hours paid per week	40
Gross pay	£457.60
PAYE Employee Tax	£43.12
PAYE Employee NI	£17.25
PAYE Employee Pension	£16.88
Net take home pay	£380.35

This pay statement is an example only and assumes:

· Tax code: 1257L

· NI Letter: A

· Enrolled for pension

· Standard holiday allowance (20+8)

Please print, sign and date below to confirm the above information has been read and understood, and that you have a good understanding of deductions from your pay required by law.

Please note: this is an example only and your pay rate and hours paid per week will be confirmed in your assignment confirmation.

Name(Required)

First Last

Signature(Required)

Student Loan

Have you ever taken out a student loan?(Required)

Yes

When did you take out your student loan?(Required)

Scotland, NI & pre-2012 England & Wales

England & Wales post-2012

Umbrella scheme / Questpay

Umbrella scheme is a wrapped up rate where employer's National Insurance contributions are deducted from the hourly rate. Holiday Pay is also deducted from the hourly rate. Holiday pay can then be accrued or paid weekly.

PAYE

PAYE pay rates are reduced from Umbrella scheme pay rates, costs of work are added on top of this and paid by Bluestones Supply Chain I.E Employer's National Insurance contributions and Holiday pay. Holiday pay must be accrued and there is no option to take this weekly.

LTD Company

LTD Company carries the same rate of pay as the Umbrella but requires a LTD company certificate, business bank account, VAT certificate where applicable. Invoices must be submitted by Sunday detailing hours/ pay also displaying bank account details.

Opted payroll:

This field is hidden when viewing the form

Please select which payroll option you are opting for:(Required)

Ltd Company

PAYE

Umbrella - Quest Pay

Umbrella - Other company

FOR INTERNAL USE ONLY

On behalf of Bluestones Supply Chain, I confirm that we have thoroughly reviewed the worker's registration information provided. We acknowledge that we have examined all details submitted and are satisfied with the completeness and accuracy of the information.

We accept this registration information as presented and agree to proceed based on the details provided herein.

Signed:

Name:

Date:

This field is hidden when viewing the form

Please state which Umbrella provider you are using:(Required)

This field is hidden when viewing the form

Please sign here to confirm your payroll option:(Required)

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

Please note, once you press submit you will be redirected to the document upload form where you need to upload the following for us to process your application:

• Driving licence – front and rear
• Digicard – front and rear
• CPC card – front and rear
• Passport or birth certificate or right to work
• Proof of National Insurance number
• Proof of address

• Photo of yourself (headshot)

Plus the following documents if you are paid through a LTD company.

• Certificate of incorporation
• Proof of business bank account
• VAT certificate if applicable

Name

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