Perfect Links Limited

12a Bourne Court

Woodford
IG8 8HD
T: 0208 550 3331
F: 0203 318 0986
E: info@perfectlinks.co.uk
W: www.perfectlinks.co.uk

Application Form
Personal Details
Date

Surname
Forenames Title (Dr/Mr/Miss/Mrs/Ms)

Address

Postcode
Tel Work
Mobile
Email
Date of Birth / / Gender Male/Female
Marital Status Nationality
National Insurance No. Are you eligible to work in the UK? YES/NO
Work Permit Required YES/NO Work Permit Valid Until / /
Driving Licence YES/NO Use of Vehicle YES/NO
Passport No. DBS Disclosure No.
Passport Expiry Date DBS Issue Date / /
Country of Passport Identity Verified Date / /

General Information
Date available for work?

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 Preferred geographical area of work?
Preferred specialist area of work?
Current rate of pay?
Interview availability?
Where did you hear of Perfect Links
Have you registered with other agencies? YES/NO
If yes, which ones?

Professional Conduct
Have you ever been the subject of a professional misconduct proceeding /
YES/NO
Disciplinary / suspension / dismissal or are such pending or threatened against you?
If Yes, please give details

Have you previously worked with children or vulnerable adults? YES*/NO

If Yes, please give details

*If Yes, Perfect Links must verify your reason for leaving with your manager.

Full Employment History (be particularly careful to provide ALL previous employment or account for gaps in employment,
college leavers must provide details of work experience during study or in holidays) – THIS SECTION MUST BE COMPLETED

Name and Address of Previous Employer From To Reason Fo

Position Held
(Starting with most recent) Month/Year Month/Year Leaving

/ /

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 / /

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References
Please give the names and business addresses of referees covering the last 3 years of work, one of whom
must be your current or most recent employer. Students must state a previous employer and course
tutor.
REFEREE 1
Name Position
Organisation
Address
Post Code
Tel Work Mobile
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 Email
Position You Held
Date From Date To

REFEREE 2
Name Position
Organisation
Address
Post Code
Tel Work Mobile
Email
Position You Held
Date From Date To

REFEREE 3
Name Position
Organisation
Address
Post Code
Tel Work Mobile
Email
Position You Held
Date From Date To

Criminal Declaration
Home Office Circular 102/88

Due to the nature of the work for which you are applying the provisions of Section 4(2) of the
Rehabilitation of Offenders Act 1974 do not apply by virtue of the Rehabilitation of Offenders Act 1974
(Exceptions) (Amendments) Order 1986. Applicants are therefore NOT entitled to withhold information
about convictions which for the purposes are “spent” under the provisions of the Act, and in the event of
employment, any failure to disclose such convictions may result in your removal from our
register/assignment. The information given will remain confidential and only taken into account where, in
the reasonable opinion of Perfect Links, the offence is relevant to the post for which you are applying.

The information that you provide in this Declaration will be processed in accordance with the Data
Protection Act 1998 and will only be used for the purpose of determining your suitability for a particular
vacancy.

Have you ever been convicted of a criminal offence in the United Kingdom or in any
YES/NO
other country?
If Yes, please give details

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 Do you have any criminal proceedings pending? YES/NO
If Yes, please give details

You have been asked to apply for a DBS Disclosure as you will be working with children or vulnerable
adults
You can refuse to apply for a Disclosure, however it is required by law for the post you are applying and
should you refuse we will be unable to place you in work.
If you already have a Disclosure you will still need to apply for a new one through Perfect Links,
however if your current one is less than one year old, then you will be able to work whist waiting for the
new one, if the client allows this.
A charge of £58.00 is made for your Disclosure, this is arranged by DBS, and it is not Perfect Links
decision to charge a fee.
You must pay for your Disclosure by cash or cheque when registering with us and we will
give you a receipt for this.
If you do not have a DBS processed thorough Perfect Links before you start work, after 4
weeks of working for a client £58 will be deducted from your wage to have a DBS processed
through Perfect Links.
If you already work for us and your DBS requires renewal, the charge will be deducted from the next
payroll after the request has been sent.
The Disclosure will be sent to both you and Perfect Links, your copy will be yours to keep and can be
used when applying to work for other organizations.
Disclosures do not have a valid until date, Perfect Links needs them to be renewed on an annual basis,
this is because our clients have specified this period.
Disclosures cannot be obtained by members of the public and are only available to organisations for
those professions, offices, employments, work and occupations listed in the Exceptions Order to the
Rehabilitation of Offenders Act 1974.

Please Complete Below

I agree that a charge of £58 will be deducted directly from my salary with Perfect Links when I start
work and do not have a Perfect Links DBS and/or when my DBS needs renewing in the future. I hereby
give permission to deduct the full fee.

Signed _______________________ Name (please print) ____________________________

Date _______________________

Full Name (Dr/Mr/Miss/Mrs/Ms)

Present Address

Postcode
I have lived at this address since:

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 Previous Address (must cover previous five years) :

Postcode
From To

Previous Address (must cover previous five years) :

Postcode
From To

Previous Address (must cover previous five years) :

Postcode
From To

Date of Birth: Place of Birth:

Have you ever been know by any other names:
If Yes, please give details:
YES/NO
Do you have a maiden name? YES/NO If Yes, please give details:

What is your height:

What is the colour of your eyes?
Have you any other identifying particulars?
I consent to the above information being checked with the police and I am aware that any ‘spent’
convictions will be disclosed.

Working Time Directive 1998 Opt Out Of Maximum Hours:

WTD 1998 says that you the Temporary Worker do not have to work on an Assignment with the Client
on an excess of 48 hour Working Week unless you agree in writing that this limit should not apply
□ YES I consent to opting out of Maximum hrs □ NO I don’t want to work more than 48 hrs

Emergency Contact Details

Name Relationship
Address

Postcode Country
Tel Mobile

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Payment Details
Bank/Building Society Name PAYE
Sort Code Company Name
A/C No. (8 digits) VAT Registration No.
Building Society Roll No. P45/P46/P38 Received? YES/NO
Account Holder’s Name

Training Declaration
I have attended a formal training course and can produce a certificate for the following:
Health & Safety YES/NO Dated

Manual Handling YES/NO Dated

First Aid YES/NO Dated

Food Hygiene YES/NO Dated

Safeguarding YES/NO Dated

Medication YES/NO Dated

I understand that I must at all times, avoid moving and handling any person or object which may put my
physical health, or the clients well-being at risk.

I will attend the next available training course through perfect links

If you fail to attend any course you have been booked on, £50 will be deducted from your salary; for each
course unless you give 2 days’ notice.

Signed _______________________ Name (please print) ____________________________

Date _______________________

HIV/AIDS Infected Healthcare Workers

The Department of Health issued guidance on HIV/AIDS infected Healthcare Workers; “Guidance on the
management of Infected Healthcare Workers”

Your attention is drawn to the ethical responsibilities of Healthcare Workers drawn up by the General
Medical Council, the General Dental Council and the UK Central Council for Nursing, Midwifery and
Health Visiting.
The key recommendations are:
1. All employees should routinely follow existing general infection control policy and adopt safer
working practices to prevent the transmission of HIV infections.
2. All employees have an ethical duty to protect patients. Those who believe they may have been
exposed to infection with HIV in their personal life or during the course of their work must seek
medical advice and, if appropriate, diagnostic HIV antibody testing.
3. HIV infected employees should not undertake procedures that may place patients at even a
remote risk of infection. These procedures are defined as exposure prone invasive procedures.*
4. All employees found to be infected must seek appropriate medical and occupational advice and
those who perform or assist in exposure prone invasive procedures must obtain further advice
on their practices, which may need to be modified or restricted to protect patients. The
appropriate advice may be sought from the Occupational Health Department at any hospital.

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 5. HIV infected employees who continue to work with patients must remain under close medical
supervision and receive appropriate medical and occupational advice as their circumstances
change.
6. Employees found to be HIV positive and who have performed exposure prone invasive
procedures whilst infected must cease these activities immediately and inform their employing
authority.
7. Personal Physicians or Occupational Health Physicians who are aware that infected Healthcare
workers under their care have not sought or followed advice to modify their practice must
inform the employing authority and appropriate regulatory body. Where an employee is not a
member of such a body, the physician will inform only the employing authority.
8. All matters arising from and relating to the employment of HIV infected employees will be co-
ordinated by an Occupational health Physician.
9. Health Authorities /Trusts will make every effort to arrange suitable alternative work and
retraining, or, where appropriate, early retirement for HIV infected employees.
10. The Department of Health and in particular, the Occupational Health Department respects its
duty to keep information on the health, including HIV status, of employees confidential, and is
not legally entitled to disclose that an employee has a HIV infection, except where the employee
consents, unless to do so would be in the public interest. A decision to disclose such information
without consent would be carefully weighed and authorities making such a disclosure may be
required to justify their decision.

*EXPOSURE PRONE INVASIVE PROCEDURES

Examples of procedures where infection might be transmitted are those in which hands may be in
contact with sharp instruments or sharp tissues (spicules of bone or teeth) inside a patient’s body cavity
or open wound, particularly when the hands are not completely visible. Such procedures should not be
performed by HIV infected employees.

Equal Opportunities Monitoring Form

Perfect Links is committed to a policy of equal opportunities in its employment practices. The following
information will assist Perfect Links to ensure that its Equal Opportunities Policy is effective. It will only be
used for monitoring purposes and will be treated as confidential. Please note that you do not have to
provide this information if you prefer not to.

Gender
Male / Female

Disability
Do you consider yourself disabled? YES/NO
Are you registered as disabled? YES/NO

Ethnic Monitoring Categories

White
British YES/NO
Irish YES/NO
Other (please specify)
Mixed
White and Black Caribbean YES/NO
White and Black African YES/NO
White and Asian YES/NO
Other (please specify)
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Asian or Asian British
Indian YES/NO
Pakistani YES/NO
Bangladeshi YES/NO
Other (please specify)
Black and Black British
Caribbean YES/NO
African YES/NO
Other (please specify)
Chinese or any other Ethnic Group
Chinese YES/NO
Other (please specify)

Checklist
Please ensure that you have provided your Perfect Links Consultant with the following documentation:
CV YES/NO
Your original passport* YES/NO
Valid work permit or visa YES/NO
Driving Licence YES/NO
One passport sized photograph YES/NO
DBS certificate or Completed DBS Disclosure Application Form
YES/NO
(Your DBS certificate should not be more than one year old)
Immunisation Certificate(s) YES/NO
Qualifications/training certificates relevant to the engagements you wish to
YES/NO
undertake with Perfect Links
Two proofs of address (utility bill or credit card/bank statement within 3 months) YES/NO
Either P45/46 or limited company certificate YES/NO
Bank details YES/NO
*If you are sending your registration form and supporting documents by post, photocopies will be
sufficient although a copy of your passport must be certified by a professional person, or a person of
standing in the community. Examples include bank or building society officials, police officers, civil
servants, ministers of religion, and persons with professional qualifications (teachers, accountants,
solicitors, etc).

The person certifying your identity must not be related to you by birth or marriage, nor live at your
address. The person must also have known you for at least two years.

The person certifying your identity must certify, sign and date a copy of your passport with the words,
“I certify that this is a true likeness of (give full name and title)”.

The person certifying your identity must also fill in their details below:
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 Surname
Forenames Title (Dr/Mr/Miss/Mrs/Ms)

Employer’s Name
Employer’s Address

Postcode
Tel Work Mobile
Email

Capacity in which you are known to the applicant?

Length of time you have known the applicant?

Refer a Friend
Name of Referred Friend
Job Title
Candidate’s address

Postcode

Tel Work
Mobile
Email

Declaration
I have filled in the application form (pages 1-10) to the best of my knowledge and understanding, and I
have omitted no relevant details. I accept that I may be required to undertake a medical check and that I
will inform Perfect Links of any changes in my medical status. I also understand that if any false
statements are made this may result in the termination of my contract for services.

 I hereby give my consent for all my details to be stored on computer

 I confirm that I have registered with Perfect Links through my own choice

 I confirm that should any of my personal details change, I will inform Perfect Links immediately
 I accept that Perfect Links have no obligation to find me employment, nor do I have any
obligation to accept offers of temporary employment through Perfect Links
 I confirm that I have read and understood the information in this application form
 I confirm that I am not an employee of Perfect Links, nor that I have any intention of becoming
an employee of Perfect Links
 I confirm that should I accept a position of temporary worker through Perfect Links, that I am
under the direction, supervision and control of the client at all relevant times

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Signed _______________________ Name (please print) ____________________________

Date _______________________

Perfect Links will hold and process your data for recruitment purposes only and from time to time may contact you for market research purposes and to
make further offers to you. If you would prefer not to be contacted once you are no longer seeking work through us please contact your local office.

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