Please complete all sections carefully. Items marked * are required.
Full Name *
Email Address *
Date of Birth *
National Insurance Number (if known)
Address *
Post Code *
GenderMaleFemalePrefer not to say
Select only one statement (A, B or C):
—Please choose an option—A — This is my first job since last 6 April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.B — This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive a State or Occupational Pension.C — As well as my new job, I have another job or receive a State or Occupational Pension.
Name of Account Holder *
Name of Bank *
Sort Code *
Account Number *
Branch Address *
If the account is not in your name: I authorise my wages to be paid into this account and agree to notify Payroll in writing of any change. I understand the company is not responsible if monies are not passed to me by the account holder.
Authorisation Name (only if account is not in your name)
I agree to the third-party account authorisation above.
Print Name *
Signature of Candidate *
Date *
PB Recruit