Please note fields marked with a *star are required.
This form will ask you a series of questions relating to your employment, you will need bank details, national insurance numbers and other personal details to hand to complete the form.
Please note once you have started the form you will not be able to save your progress so any changes may be lost if you close or refresh your browser.
Once you have finished press submit, if the form is successful you will be presented with a thank you message, if you have made an error you will be returned to the start and you can progress back through the form to correct any mistakes.
You can track your progress on the progress bar below, the form should only take 15 minutes to complete. If you are unsure of any answers please use your best guess and contact us on the details contained in your correspondence to discuss.
Select the site from the drop down box below
Please provide your employment details as detailed on your offer letter.
Do not choose this statement if you are in receipt of a State, Works or Private Pension.
Choose this statement if the following applies.
This is my first job since 6 April and I have not been receiving payments from any of the following:
Do not choose this statement if you are in receipt of a State, Works or Private Pension
Since 6 April I have had another job but do not have a P45. And /or since the 6 April I have received payments from any of the following:
Choose this statement if:
Tell us if any of the following statements apply to you:
-you do not have any Student or Postgraduate Loans
-you’re still studying full-time on a course that your Student Loan relates to
-you completed or left your full-time course after the start of the current tax year, which started on 6 April
-you’re already making regular direct debit repayments from your bank, as agreed with the Student Loans Company
Question Two Guidance
Types of Student Loan
You have Plan 1 if any of the following apply:
you lived in Northern Ireland when you started your courseyou lived in England or Wales and started your course before 1 September 2012
You have Plan 2 if:
You lived in England or Wales and started your course on or after 1 September 2012
You have Plan 4 if any of the following apply:
You lived in Scotland and applied through the Students Award Agency Scotland (SAAS) when you started your courseYou have a Postgraduate Loan if any of the following apply:you lived in England and started your Postgraduate Master’s course on or after 1 August 2016you lived in Wales and started you Postgraduate Master’s course on or after 1 August 2017you lived in England or Wales and started your Postgraduate Doctoral course on or after 1 August 2018
Please complete this questionnaire honestly and accurately. The purpose of this questionnaire is to help us understand whether there are any health-related matters, disabilities, medical conditions, illnesses, injuries or workplace support needs that may affect your ability to carry out the role safely and effectively.
This questionnaire should be completed after an offer of employment has been made. The information you provide will be treated confidentially and only used where relevant to your employment, workplace safety, reasonable adjustments, occupational health advice or our legal obligations.
The information you provide in this questionnaire is health-related personal data and will be treated as confidential.
We will only use this information for relevant employment purposes, including assessing fitness for work, identifying reasonable adjustments, meeting health and safety obligations, arranging workplace support, and deciding whether Occupational Health advice may be needed.
Access to this information will be restricted to those who reasonably need it for these purposes. Where Occupational Health advice is sought, we will usually ask the Occupational Health provider to provide recommendations about fitness for work, adjustments, support or restrictions, rather than detailed medical information, unless this is necessary and appropriate.
Your information will be stored securely and retained only for as long as necessary in line with our data protection obligations and retention practices.
By submitting this questionnaire, you confirm that:
you have read and understood why this information is being requested and how it will be used;
you understand that the information provided may include health information, which is classed as special category personal data under data protection law;
you understand that the organisation will process this information only where it is necessary and lawful to do so, including for relevant employment purposes, health and safety, reasonable adjustments, workplace support, Occupational Health advice, and compliance with legal obligations;
you understand that access to this information will be restricted to those who reasonably need it for the purposes explained in this questionnaire and any relevant privacy notice;
you understand that, where appropriate, the organisation may contact you to discuss the information provided or to request further information;
you understand that an Occupational Health referral may be recommended if further specialist advice is reasonably needed, and that separate information will be provided about that process where applicable.
I confirm that the information I have provided is true, accurate and complete to the best of my knowledge.
I understand that failing to disclose relevant information, or providing false or misleading information, may affect the organisation’s ability to support me safely at work and may be dealt with in accordance with the organisation’s procedures.
I understand that if my health circumstances change before or during my employment, I should inform the organisation where this may affect my ability to carry out my role safely and effectively, or where workplace support or reasonable adjustments may be required.
Voluntary agreement to opt out of the 48-hour average weekly working limit
You agree that you may work for more than an average of 48 hours per week, where this is required and agreed in connection with your role. You understand that this average is normally calculated over the relevant reference period under the Working Time Regulations 1998.
You understand that this agreement is voluntary. You also understand that you do not have to agree to opt out of the 48-hour average weekly working limit and that you must not be treated unfairly or subjected to any detriment if you choose not to sign this agreement.
You understand that you may bring this opt-out agreement to an end at any time by giving the Company three months’ notice in writing.
By signing below, you confirm that you have read and understood this agreement and that you voluntarily agree to opt out of the 48-hour average weekly working limit on the terms set out above.
Shift pattern acknowledgement
You understand that your role may involve varying shift patterns, which may include early shifts, late shifts, weekends, bank holidays and other working patterns required by the needs of the business.
The Company will manage working hours, rest breaks and rest periods in line with the Working Time Regulations 1998 and any applicable exemptions. Where an exception applies and reduced rest is required, the Company will take appropriate steps to provide compensatory rest where required.
This acknowledgement does not remove or waive any statutory rights to rest breaks, daily rest or weekly rest under the Working Time Regulations 1998.
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