Application Form

EDUCATION/QUALIFICATIONS/TRAINING – Please include any training undertaken that may be relevant to your application for work.

First Referee

Second Referee

By signing this declaration, you are giving us permission to contact your references listed above:

Working Time Regulation 1998 – Opt Out Agreement

Definitions:
1. In this agreement the following definitions apply;
“ASSIGNMENT” means the period during which the Flexible Employee is employed to render services to the
client.
“CLIENT” means the person, firm or corporate body engaging the services of the Flexible Employee.
“WORKING WEEK” means the average of 48 hours each week calculated over a 17-week period.
1.2 References to the singular include the plural and reference to the masculine include feminine and vice versa.
1.3 The headings contained in their terms are for convenience only and do not affect their interpretation.
2. RESTRICTION
2.1 The working time regulations 1998 provide that the Flexible Employee shall not work on an assignment with the
client in excess of the working week unless he/she agrees in writing that this limit should not apply.
3. CONSENT
3.1 The Flexible Employee herby agrees that the working week limit shall not apply to the assignment.
4. WITHDRAWAL OF CONSENT
4.1 The Flexible Employee may end this agreement by giving 3 months’ notice in writing.
4.2 For the avoidances doubt, any notice bringing this agreement to an end shall not be constructed as
termination b the Flexible Employee 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.
5. THE LAW
5.1 These Terms are governed by the English Law and are subject wot the exclusive jurisdiction of the English Courts.

Flexible Employee Health & Safety Declration

All employees must have a Health and Safety Policy stating is responsible for Health and Safety and the Health and Safety arrangements in place. All Flexible Employees have a duty under the Health and Safety Act to take reasonable care to safeguard their own safety and the safety of anyone who may be affected by their work activities and actions and to co-operate with the Client and others in meeting statutory regulations. It is your responsibility to familiarise yourself with the Clients; policy, particularly the procedures for fire, first aid and accidents upon arrival at the Clients premises. The Act also requires Flexible Employees not to interfere with or misuse anything provided to protect their health safety or welfare in compliance with the Act. Please refer to he Health and Safety section in your Employee Handbook for further information.

Please complete the following questions to aid Will Barnes Ltd in providing you with the right environment to working and to cater for any special needs you may have.

Health Self Assesment Declartion for Night Workers

In compliance with the Working Time Regulations the purpose of this declaration is to assess your fitness to carry out nightwork whilst on assignment from Will Barnes Ltd.

Whilst there is no difference in the physical demands of night work compared today work the human body is naturally programmed sleep at night. The disruption to this sleep pattern can aggravate certain medical conditions, all be it often temporary. Additionally, the reduced access to services and facilities that may be apparent both inside and outside the workplace at night can have an effect.

Please answer the following questions. If your answers raise doubts about your fitness for night work, then you may not be assigned to clients for night work unless you are able to provide proof that you are physically able to do so having been assessed by a suitably qualified health care professional.

I have read and completed the above Health & Safety Declaration to the best of my knowledge and understand that I must inform Will Barnes Ltd of any changes to the above personal information that may affect my ability to undertake assignments.