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Application form - Umbrella service

If you would prefer a printable copy of this form, please click here.
Fields with are required.
■ Personal details
Title: Address:
Home phone: -  
Work phone: -  
Mobile phone: - Post code:
Email address: Date of birth:
Occupation: Gender:   Male    Female
Nationality: NI number:
■ Banking details
Name of bank and branch:
Name of account holder:
Sort code: - -
Account number: -
Building society ref.:
Recruitment agency or client details
Agency name:
Post code:
■ Assignment particulars
End client: Start date:
Assignment address:   End date:
Have you worked for this end-client at this site in a similar role within the last six weeks?:   Yes   No
■ My billing rates
Rate per :   Pay frequency:   Weekly   Monthly
■ Right to work in the UK
N.B. Please select from LIST A or LIST B only. Prior to processing your first salary payment, CERTIFIED copies or the ORIGINALS of the applicable documents are required.
A passport or National Identity Card showing that you are a British Citizen, a EU or Swiss national
A UK residence permit issued to a EU or Swiss national
A Home Office document stating that you have right of residence in the UK as the family member or EU/Swiss national
A passport endorsed to show you can stay indefinitely in the UK
A passport / travel document endorsed to show you can stay in the UK and can do the type of work you have applied to do
An Application Registration Card issued by the Home Office to an asylum seeker stating you are permitted to take employment
 A P45, P60 or National Insurance Card giving your permanent National Insurance Number and Name, PLUS ANY ONE OF THE FOLLOWING:
A full UK birth certificate issued in the UK or a birth certificate issued in the Channel Islands, Isle of Man or Ireland
A certificate of registration stating you are a British Citizen
A letter or an Immigration Status Document from the Home Office indicating you can stay indefinitely in the UK
A letter from the Home Office stating you can stay in the UK and can do the type of work you have applied to do
■ Income tax documents
These are required in order to ensure that you pay the correct amount of tax
EITHER: I will send my P45 from my previous employer (parts 2 and 3 only)
OR: My P46 information is as follows:
     This is my first job since last 6th April and I have not been receiving taxable Jobseekers Allowance or taxable Incapacity Benefit or a State or Occupational Pension
   OR  This is now my only job, but since last 6th April I have had another job or have received taxable Jobseekers Allowance or Incapacity benefit. I do not receive a State or Occupational Pension
   OR  I have another job or receive a State or Occupational Pension
  If you left a course of Higher Education before last 6th April and received your first Student Loan instalment on or after 1st September 1998 and you have not fully repaid your Student Loan, tick this box. (If you are required to pay your Student Loan directly through your own Bank or Building Society Account then do not tick this box).
  Tick this box if you have a Plan 2 Student Loan - Only if you lived in England or Wales and started your course on or after 1st September 2012.
■ My agreement
1. I confirm that the information supplied is to the best of my knowledge correct and that I am entitled to work in the UK.
2. I will provide the required proof of entitlement to work in the UK as requested above.
3. I agree to the fees as outlined on the web site.
4. I hereby consent to the information relating to me being passed to QIS group companies in order that they may properly carry out their duties, rights and obligations as my employer. I understand that such processing will principally be for personnel, administrative and payroll purposes.
5. I acknowledge that there may be occupational limitations to QIS' insurance, for high risk professions such as Medical, Offshore Oil and Gas, etc. and have given this consideration.
Name:   Date: 17/06/2024