Section 2: Right To Work Check

Immigration Status

Do you have immigration permission to work in the UK?
YES NO
If permission is restricted, note any restrictions:

In line with Home Office guidance on the prevention of illegal working, we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by London Recruitment Agency for temporary work.

Qualifications

Food and Hygiene Certificate
YES NO
Allergens Certificate
YES NO
Declaration: Yes

Employment History

Personal Reference (Must Cover 3 Years)

Name: Occupation: Relationship: How long known: Email Address: Phone: Address:

Professional Reference 1 (Most Recent Employer)

Name: Company: Dates (from - to): Email Address: Phone: Address:

Professional Reference 2 (Most Recent Employer)

Name: Company: Dates (from - to): Email Address: Phone: Address:

Section 3: Availability

Availability

Shift Type	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Days
Nights
OFF
Current Week Dates	10-08-2026	11-08-2026	12-08-2026	13-08-2026	14-08-2026	15-08-2026	16-08-2026

Other Information

Dates of any pre-booked holidays: ( Optional ) What date are you available to start? Temporary Permanent Consultant’s Notes:

Section 4: Declaration

If you have declared any convictions you are welcome to provide us with any additional information that you think may be relevant and which will help us to determine your suitability to be put forward for roles with our clients. This could include for example information about the circumstances of the offence, any work (paid or voluntary) or training that you have undertaken since, change in your circumstances etc. We will seek to put forward/supply the best possible candidates to our clients. Having a criminal conviction will not necessarily exclude you from the process. The information given will be treated in the strictest of confidence and only taken into account where, in our reasonable opinion, the offence is relevant to the post to which you are applying. Failure to declare a conviction may require us to exclude you from our register if the offence is not declared but later comes to light. If you are working in an assignment with a client at the time that we are made aware of a conviction that you have not disclosed to us, we may be legally required to inform our client of that information and your assignment may be terminated.

Health & Disability

The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought.

If you have a disability, what reasonable adjustments do you require to access this recruitment service, attend interviews, and assessments? Please specify: Do you have any health issues or a disability relevant to the position or role you seek? Yes No If yes, please specify: If applying for night work, would you like the opportunity to receive a night worker's health assessment? Yes No

Please note that should your application be successful, you may be asked separate assignment/client specific health questions. These will be stored separately from your application.

By signing this declaration, I consent to you holding and processing my data under the rules of the Data Protection Act 1998. How may we contact you regarding your application? (Select all that apply): Telephone Fax Letter SMS text msg Email

Agency Workers Regulation

In order to ensure you receive your full rights under the Agency Workers Regulations 2010, have you in the past 6 weeks been hired by an employment business to carry out work for their clients? Yes No If yes, please specify the clients you worked for, the location, and your job title: Have you taken time off the assignment(s) with the other employment business which may impact your qualifying period rights under the Agency Workers Regulations? ( Optional )

It is your responsibility to let your branch know if you take on any work through another agency while you are engaged by us.

Statement of Confidentiality

I understand that during and after an assignment:

1. I will keep secret and confidential all information made available to me about any customer, any member of staff, or the business of the client(s) I have been assigned to.
2. I will keep all such information secure and will not disclose it nor allow it to be disclosed to any unauthorized person.
3. Upon completion or end of my assignment, I will return all property, ID, paperwork, and any associated items to a representative of yours or the client’s representative.
4. I understand that the above undertakings are terms of my assignment and should I break any of them, this may result in action, not excluding Civil or Criminal Prosecution being taken against me. This includes the Data Protection Act 1998 and any variations that may be made to this in the future.

Unspent Criminal Offences

Do you have any unspent criminal convictions? Yes No If yes, please list any unspent criminal convictions and their dates below. The information you provide will be treated in confidence and only taken into account where, in our reasonable opinion, the offence is relevant to the post for which you are applying:

Section 5: Payment Details

I would like London Recruitment to pay me for the work by direct debit transfer to my bank account.

Applicant Name: NI Number: Account Sort Code: Account Name: Account Number: Bank or Building Society Name: Building Society Account Reference Number:

You are confirming that the details given above are correct to the best of your knowledge and that You accept liability for any problems arising from the incorrect completion of Yours BACS payment details.

We share your details with our appointed Payroll Company. As part of GDPR, we need your consent for this (if applicable).

Consent to Share Your Details

Yes, I consent to share my details.

Note: You must select "Yes" to proceed.

Section 6: Working Regulations 1998 Opt-Out Agreement

If you are 18 or over and wish to work more than 48 hours a week, you can choose to opt out of the 48-hour limit. This is voluntary.

I hereby confirm my agreement to waive the restriction on the 48-hour average weekly working time as set out in the Working Time Regulations 1998. I understand that this agreement can be terminated by me giving not less than three months’ written notice to London Recruitment.

I confirm my agreement to opt out of the 48-hour limit. ( Optional )

By signing this document, I confirm I have read and fully understood the statements above and agree to abide by them. I also declare that all the information I have given is true and accurate to the best of my knowledge. I understand that failure to declare an accurate account of information may lead to consequences.

Date:

Office Use Only

Consultant Name: Consultant Signature: Dated:

Section 7: Catering Skills

Please tick the categories in which you have experience and would like to work:

KITCHEN FOOD SERVICE	DIRECTORS / DINING BOX	DIRECTOR’S CHEF	CASHIER / TILLS
KITCHEN PORTER	CHEF	BAR PERSON	RECEPTION
WAITING	COOK	FOOD SERVICE ASSISTANT	CUSTOMER SERVICE ASSISTANT
TEA / COFFEE SERVICE	COMMIS CHEF	CLEANER / DOMESTICS	CATERING MANAGER
PLATE WAITING	CHEF DE PARTIE	VENDING OPERATOR	BANQUETING MANAGER
SILVER SERVICE	GRILL CHEF	GENERAL ASSISTANT	SENIOR CUSTOMER SERVICE ASSISTANT
BUTLER SERVICE	PASTRY CHEF	CHAMBER PERSON / ROOM ATTENDANT	HEAD CHEF
WINE WAITING	SOUS CHEF	HOUSEKEEPER	RESTAURANT CHEF MANAGER

Have you worked in any of the following environments?

HOTELS	RESTAURANT	PUB	MUSIC / SPORTS EVENTS
CONFERENCE & BANQUETING	CAFE	CANTEEN	RETAIL SHOP
SCHOOL	HOSPITAL	FAST FOOD OUTLET

Do you have?

CHEF'S KNIVES	CHEF'S WHITES	SAFETY SHOES	WHITE SPORTS
BOW-TIE	WHITE OVERALLS	FLAT BLACK SHOES	WAISTCOAT
BLACK SKIRT / TROUSERS

Section 8: Medical Questionnaire

Please Note: This questionnaire is only to be completed once you have registered in full. In order for London Recruitment to ensure that any assignments you are offered pose no threat to the health and safety of yourself, your colleagues, or the public, or so that we can consider what reasonable adjustments may be necessary in a particular assignment, please complete the relevant parts of this questionnaire fully and accurately. It may be necessary for your consultant to request further details of any aspect of your health for these purposes.

GENERAL

Condition	Yes	No	Date/Details
Ear trouble or deafness
Eye trouble or defective vision not corrected by glasses
Back trouble, other muscle or joint trouble
Breathing issues such as asthma, hay fever or other chest trouble
Circulatory issues such as heart trouble, high or low blood pressure, varicose veins
Epilepsy, giddiness, fainting attacks, fits or blackouts, recurring headaches

Should we be aware of any matter affecting your ability to:

Activity	Yes	No	Date/Details
Stand
Sit
Walk
Lift
Climb Stairs
Use your hands

INDUSTRIAL / CONSTRUCTION

Condition	Yes	No	Date/Details
Work at heights on ladders / staging
Work in confined spaces
Ability to drive a motor vehicle or mechanical equipment

CATERING / FOOD PRODUCTION

Condition	Yes	No	Date/Details
Recurring stomach or bowel trouble
A nasal infection
A cough with phlegm / sore throat
A discharging ear
Acne, boils, styes, burns or septic fingers
Diarrhea, abdominal pain or fever

If “Yes,” a doctor’s certificate will be stating you are safe to return to work before you can be offered assignments.

Have you had any time off in the last 2 years because of illness or injury?

Yes No

Have you now made a full recovery from your illness or injury?

Yes No

If no, a doctor’s certificate is stating that you are safe to return to work.

Are you taking any prescribed medication that may affect your ability to drive, operate machinery, or otherwise perform your duties?

Yes No

Have you, to your knowledge, any physical, mental or other condition that we should take into consideration when offering work?

Yes No

Section 9: Food Allergens - Query Response

People with food allergies have to be very careful about what they eat in order to prevent a reaction occurring. As you may be aware, food labelling on pre-packed foods has been in place for some time.

Food allergens in non-pre-packed food (e.g. a restaurant/food service counter) must provide clear information about the ingredients.

The 14 major food allergens are:

1. Cereals containing gluten
2. Crustaceans, e.g. prawns, crabs, lobster and crayfish
3. Eggs
4. Fish
5. Peanuts
6. Soybeans
7. Milk
8. Nuts, such as almonds, hazelnuts, walnuts, pecan nuts, Brazil nuts, pistachio, cashew, and macadamia (Queensland) nuts
9. Celery and celeriac
10. Mustard
11. Sesame
12. Sulphur dioxide, a preservative found in some dried fruit
13. Lupin
14. Molluscs, e.g. clams, mussels, whelks, oysters, snails, and squid

As a London Recruitment Employee working in catering assignments, you may be working for various clients. In order to ensure that you are adhering to the new rules for all clients, please familiarise yourself with how to respond to a customer with a food allergen/ingredients query as shown on the next page.

DECLARATION

I confirm that I have read and understood how I should respond to a customer with a food allergen/ingredients query and I will follow this process when working in a catering assignment.

Consent Confirmation

Yes, I confirm that I have read and understood the process and will follow it.

Note: You must select "Yes" to proceed.

Section 10: Equal Opportunities Policy

KACD Limited t/a London Recruitment Agency is committed to a policy of equal opportunities for all work seekers and shall adhere to such a policy at all times and will review on an on-going basis on all aspects of recruitment to avoid unlawful or undesirable discrimination. We will treat everyone equally irrespective of sex, sexual orientation, gender reassignment, marital or civil partnership status, age, disability, colour, race, nationality, ethnic or national origin, religion or belief, political beliefs or membership or non-membership of a trade union and we place an obligation upon all staff to respect and act in accordance with the policy. London Recruitment Agency shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment, or in any terms of employment or terms of engagement for temporary workers. London Recruitment Agency will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualification and ability to perform the relevant duties required by the particular vacancy.

London Recruitment believes in equal opportunities for all in the workplace. Candidates are selected on the basis of their knowledge, skills, attitude, and experience, and we do not disadvantage any candidate on the grounds of gender, disability, ethnic origin, religion, marital status, sexual orientation, or nationality. We will not tolerate any form of discrimination, victimisation, or harassment.

As a London Recruitment Employee working in catering assignments, you may be working for various clients. In order to ensure that you are adhering to the new rules for all clients, please familiarise yourself with the policies outlined.

EQUAL OPPORTUNITIES - MONITORING CHECKLIST

For monitoring purposes, please complete the following:

Gender:

Male Female

Please tick the box below which best describes your ethnic origin:

White:

British Irish European Other

Asian or Asian British:

Indian Pakistani Bangladeshi Other

Chinese or Chinese British or other ethnic group:

Chinese Other

Mixed:

White and Black Caribbean White and Black African White and Asian Other

Black or Black British:

Black Caribbean Black African Other

Do you consider yourself to have a disability?

Yes No

Section 11: New Starter Declaration

DOCUMENT ATTACHMENTS

Attach CV: Attach Passport: Right to Work Documentation (BRP, Share Code for non-British passport holders): Attach Training Certificates (Food Safety, Hygiene, Allergens): Attach Training Certificates 2 (Food Safety, Hygiene, Allergens): Attach proof of address (bank statement, utility bills, council tax): Attach DBS Certificate (if available, optional):

DECLARATION

I confirm that the information I have given is correct.

Please send or give the completed form to your employer.

Section 12: Terms of Employment

Between KACD Limited as London Recruitment Agency (“the company”) registered in England and Wales No. 12487001 Registered office: 128 City Road, London, United Kingdom, EC1V 2NX and

Candidate Name: Address: Role/Position: Branch:

I acknowledge that I have received, read, and understood the London Recruitment Employee Handbook, containing my Terms of Employment. I agree to be bound by all terms contained within.

I confirm as follows:

(a) I am fully mobile and available for assignments without restriction to location or Client, as reasonably directed by the Company.
(b) I am only available to undertake assignments for the Company in a very limited area as follows: Location (e.g., only one primary postcode area):

This section should be completed where the individual is a temporary worker and is engaged via an intermediary such as an umbrella company, a personal services company, a partnership, a CIS intermediary or other or operates as a sole trader/self-employed

Intermediary details (i.e., the party receiving payment for the worker’s services):
Companies House name & registration no. (if a limited company): Unique tax reference no. (UTR) – to be completed where the intermediary or sole trader did not operate PAYE: VAT registration number of the limited company (if VAT registered):

Signed by Flexible Employee:

Date:

Signed by the Company Director: CRYSTAL JOYCE D. FURMAN

Signature: Date: Full Name: Address: