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Registration Form

Date of Registration

Title

First Name

Surname

Email Address

Mobile Number

Home Telephone Number

Date Of Birth

Full Address

Post Code

Do you hold a current UK Driving Licence?

Yes No

Nationality

Can you confirm you have the right to work in the UK? Please provide your consultant with your right to work

Yes No

Do you have any ‘unspent’ criminal convictions?

Yes No

I agree that all of the details provided on this document are accurate and complete to the best of my knowledge. I confirm I am happy for Assure Personnel to hold my details and represent me as a candidate in my job search.

Signature:

Date

I confirm that I am happy to have my CV sent out on a speculative basis to prospective clients, I understand that I will be made anonymous and my consultant will confirm with me if there are any clients I DO NOT wish to be to contacted on my behalf. This will be done within a 2 week period of when I sign this form.

Signature:

Date

Registration Form

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