PRIMECARE STAFFING SOLUTIONS LIMIT CANDIDATE REGISTRATION FORM Please complete all sections of this form in BLOCK CAPITAL using black ink
PERSONAL DETAILS Surname: Mr./Mrs./Miss/MS (Delete as appropriate) Previous Surname(s)
Forename:
Former name:
Maiden name:
Address:
Home number: Mobile number: Email address:
Post Code: Date of Birth:
Other contact details: Place of Birth:
Marital Status:
Nationality: Are you eligible to work in the UK?
Yes………………….
No……………….
Passport number………………………………
Place of issue …………………………….
Expiry date………………………………………. Do you have a work permit? Yes/ No ………………….
Work permit number…………………….
National Insurance Number ………………….
Post Applied: MNC PIN (if applicable) ……………………………….
Expiry Date: ………………………….
What part of the register are you on (if applicable) ……………………………………………………