Umbrella Employed Application Form – Pinnacle Payroll Service LTD

About You

Sex

Male Female

If you are a NON-UK National, in addition to the usual documentation we require a SHARE CODE available at this link

If you are a UK National, we require Passport, Proof of National Insurance (last payslip/P45/P60 etc) and Proof of address.

Attach your certificates here

Mailing Address

Payment Details

Please check the details above before submitting your application as Pinnacle Payroll cannot be held responsible for monies released to incorrect bank details.

Agency Details

About the Assignment

Is the Assignment

UK Based Abroad Offshore

Security Information

To ensure that your financial and personal details are only discussed with yourself, we require security information. We will request this each time you contact us.

How did you hear about us?

Next of Kin Details

To ensure that your financial and personal details are only discussed with yourself, we require security information. We will request this each time you contact us.

Next of Kin Contact Permission

Please tick this box if you would like to nominate your next of kin to be able to speak on your behalf at times regarding personal information such as your payments.

Yes No

We offer a holiday pay system which is Contractor Retained, this is paid out weekly to you.

Have you ever been convicted of a criminal offence?

Yes No

Criminal Convictions

Under the rehabilitation of offenders act 1974 you are required to give details of any convictions which are not ‘spent’. Failure to do so may render you liable to summary dismissal should you be appointed.

Health and Safety

The Health and Safety handbook details our policies and procedures for Umbrella employees.

Health and Safety Handbook Agreement

“I acknowledge I have read and understand the contents of the Health and Safety handbook and agree to comply with the policies and procedures contained within it”.

Yes No

Contract for Employment

Please read the contract for employment. Complete and sign both copies and return one copy with your registration.

Data Protection

All data we hold about you and how we process and use it complies with the data protection act. From time to time, we may offer services or products which we feel may benefit you through carefully selected third parties e.g. accountancy services or mortgage advice.

Employee Statement

Please select just one of the following statements A, B or C.

Employee Statement 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 in 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.

Student Loan Statement

I have a Student Loan which is not fully repaid. Select ‘No’ if you are repaying your Student Loan direct to the Student Loans Company by agreed monthly payments.

Yes No

Previous Employment

The Agency Worker Regulations ensure equal treatment for temporary workers in relation to an employee of the client doing the same job. As these entitlements start at week 12 we need to know prior working history if you have worked for the client in previous 18 weeks. Note we only need details below if you are starting your assignment with Pinnacle Payroll with a client that you have worked on assignment with in the last 18 weeks, this could be via a recruitment agency or another Umbrella Company.

NB: DO NOT PROVIDE DETAILS IF YOU WERE WORKING FOR THE CLIENT ON A SELF-EMPLOYED BASIS.

Please note failure to return this form will result in your payment being delayed.

I have not worked for the client that I am currently starting an assignment with in the last 18 weeks

Yes No

You are providing the information above based on the current assignment with Pinnacle Payroll. It is your responsibility to contact us and provide up to date Previous Employment History if you start another assignment with Pinnacle Payroll for a client that you have engaged with in the prior 18 weeks. By completing and signing this form you acknowledge that the responses you have provided above give a true and accurate reflection of your previous employment history.

Declaration

“I declare that the information I have provided is correct and I understand that it is my responsibility to inform Pinnacle Payroll Umbrella of any changes to my job title, personal, bank or agency details as soon as possible. Providing incorrect or false information on this application form may result in the company invoking disciplinary procedures that may end in dismissal. I also confirm that it is my intention to undertake multiple assignments and will inform Pinnacle Payroll Umbrella should my intentions change. I also agree to the terms and conditions set in the contract of employment”.

I Agree

Yes No