First Name *
Email Address *
Living Details *
---Home OwnerRentedLiving With Family
National Insurance Number *
Driving License Number *
Do you have friends or relations that work for Expert Group (UK) Ltd – Please specify who and where
Relationship To You *
Please provide your LAST WORKING position first.
NB** We will require a minimum of 2 years continuous employment history, please complete all sections, including no work periods. Due to AWR legislation, if you have previously been an agency worker we will require the client details of your work placement as well as the Agency details.
Start Date *
End Date *
Contact Name *
Company Name *
Company Address *
Company Telephone Number *
Employment Status? *
Reason For Leaving *
Company Telephone Number
Reason For Leaving
I hereby confirm that all employment details above are correct and accurate to the best of my knowledge to date.
Assignments cannot be offered, unless we have the ability to obtain a minimum of 2 (TWO) years of employment references.
References are required this section must be completed to gain assignments.
Please provide details of 2 (TWO) referees whom are able to comment on your work ability. One referee must be your last or current employer. References must cover the last 2 (TWO) years and are not able to be a family member or friend.
Employers Name *
Your Role whilst employed *
Relationship to you: *
I will inform Expert Group (UK) Limited immediately of any additional or other work undertaken by myself for a third party company.
Any assignments accepted from Expert Group (UK) Limited will keep me within the legal working time directive rules and regulations.
I will be personally responsible for the management of my working time directive hours.
A night worker is an employee who is scheduled to work at least 3 hours of his/her daily working time during night time on the majority of days on which he/she is scheduled to work. Night time is defined as the period between 11 pm and 6 am.
Night workers are entitled to a voluntary health assessment to check whether they are fit for the work to be done. Very few health problems will prevent people being able to work at night, and where there is a medical problem which could be relevant it will almost always be possible for the person to be able to work during night hours with suitable modifications to their treatment programme.
The purpose of the questionnaire is to ask whether you have any health problem which could be affected by night work, so that where necessary an appropriate medical review can be arranged. The questionnaire will be confidential to the Occupational Health Department but a report on your fitness will be provided to your manager who is responsible for work assignments and for the arrangements for health and safety at work.
Please complete the form and tick the appropriate box for the questions listed; if you have any other condition which you believe should be considered please write brief details at the bottom of the page or continue on a separate sheet of paper.
Have you had any medical problem in the past which has prevented you from working at night? *
Are you diabetic? *
Are you subject to angina, or other heart problems which may affect your fitness? *
Are you suffering from any circulatory problems which affect your activities? *
Have you had duodenal or stomach ulcers in the past, or under treatment at present? *
Have you had any continuing bowel problem, for instance following major surgery? *
Do you have any chronic chest problem such as asthma, emphysema or bronchiectasis? *
Do you have any disability affecting mobility which will cause difficulties in arranging night work? *
Do you have any recurrent or continuing sleep disturbance requiring medical advice? *
Are you having specialist care requiring your attendance at hospital clinics for treatment? *
Do you have any other health problem which affects your fitness for night work? *
Are you taking any medication to a strict timetable? *
Please give the names of any prescribed medications which you take regularly
Expert Group (UK) Limited take Health and Safety in the workplace seriously and by the nature of your employment with different Clients, the arrangements for Health and Safety will vary according to the circumstances of the assignment.
Your Personal Responsibilities are:-
I confirm that I have my own:
Safety Shoes *
Ear Defenders *
Hard Hat *
Safety Glasses *
I agree that Expert Group (UK) Limited can share my personal employment details with prospective employers. All other personal information will remain confidential unless requested by a government body, which I agree for my details to be released.
Expert Group (UK) Limited policy is to interview applicants who have a disability and who meet the essential short listing criteria. The DDA Act 1995 & 2005 define disability as “a mental or physical impairment that has a substantial and long term adverse effect on the ability to carry out normal day to day activities.
Do you consider yourself you have a disability in accordance with the act? *
Do you require any special arrangements if asked to attend an interview. We would like to ensure that you receive a fair and equal interview. For example: lip speaker, speech to text operator, audio transcription, Wheelchair access (the list is not exhaustive) *
Will you require any reasonable adjustments to be made if you were offered a position with one of Expert Group (UK) Limited’s clients? *
The amendments to the Exceptions order 1975 (2013) provide that certain convictions and cautions are “protected” and are not subject to disclosure to employers and cannot be taken into account.
Criminal Records will be taken into account only when the conviction is relevant. Declaring a conviction will not prevent you from being considered for a role with any of Expert Group (UK) Limited’s clients. The rehabilitation of Offenders Act 1974 enables criminal convictions to become ”spent” or ignored after a “rehabilitation period”, however in order to access their suitability for the post applied for all applicants are required to disclose any “unspent” (Current) criminal convictions.
Offers of employment to roles which Children or Vulnerable Adults are concerned will be subject to a satisfactory check for criminal records, protection of Vulnerable adults (POVA) and protection of children (POCA) with the Criminal Records Bureau before the role is confirmed. These checks will request details of cautions reprimands or final warnings, plus any convictions and will check if you are on the POVA or POCA lists.