Self Employed Field Agent Application

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1 Self Employed Field Agent Application Roles Doc Completion Statement Taking Locus Report Floor Plans Photography EPC's Title, for example Mr, Mrs, Miss, Ms, Surname or family name Forename(s) of birth DD / MM / YY Marital Status Single / Married / Separated Divorced /Other Current Address please include the amount of time spent at the address. Previous address Only complete if less than 5 years at current address. Postcode Time spent at the address Postcode Home telephone Mobile number address Next of kin Name: Address: Relationship: Contact number: NI Number

2 Are you VAT registered? Please circle as appropriate and provide VAT number if known. VAT number Do you hold a full Driving Licence? Availability Monday AM PM Please use the box below to update your current availability. Tuesday AM PM Wednesday AM PM Thursday AM PM Friday AM PM Saturday AM PM Sunday AM PM Postcode coverage Please list all postcodes you are able to cover.

3 Equipment Please tick to confirm what equipment you have from the list in the provided Car Laptop Desktop Tablet Mobile Phone Scanning application Portable Scanner Printer Ability to print colour Digital SLR Measuring Wheel Locus drawing software Dictaphone Please specify your mobile phone make and model References Please provide TWO references including full address, contact numbers and how you know them. 1 Reference Name: Address: Relationship: address: Telephone number: 2 Reference Name: Address: Relationship: address: Telephone number: Postcode: Postcode:

4 Qualifications Please list all qualifications you currently hold. (please attach evidence to your application) Data Protection Act Dox2you (trading as Quickdox) retain information consent relating to you subject to the Data Protection Act Please read the Data. Protection Act consent. By signing this application form, you consent Quickdox Sign and date at the processing, both manually and by electronic means, bottom to consent. your personal data for the purpose of assessing your application and the administration and management of your self employed contract with us. By signing this form you consent Quickdox and any other group company processing sensitive personal data both manually and by electronic means for the same two purposes Consent / Declaration signature

5 Code of conduct / Rehabilitation act Have you ever been convicted of a criminal offence other than any spent convictions under the rehabilitation of offenders act 1974? Please circle as appropriate Code of conduct / Rehabilitation act Please delete as appropriate. Sign and date at the bottom I confirm that I HAVE / HAVE NOT been: charged with a criminal offence; convicted of a criminal offence; received a caution in relation to a criminal offence; or placed on the sex offenders register. I undertake to inform Quickdox of any above matters if they occur during the term of my agency agreement I confirm I have the following conviction(s) I understand that I am required to disclose one or more of the following matters; I have been charged with a criminal offence; I have been convicted of a criminal offence; or I have been placed on the sex offenders register. Declaration signature Where did you hear about the vacancy?

6 Consent / Declaration by applicant Please sign to confirm and consent to the following. I confirm that the above information is correct and that I undertake to notify Quickdox of any changes of the above. I understand that any false or misleading information will disqualify me from being self employed with Quickdox Please consent to the following: 1. Consent for a credit/electoral role check to be made 2. Consent for references to be obtained 3. Verification of identity check to be made I give authorisation for Quickdox to conduct the checks as indicated above. Consent / Declaration signature Self Employed I confirm that I have been self employed for declaration Years Months As you are self employed, you are required to provide I understand that I am liable for notifying and paying the an INLAND REVENUE Inland Revenue Tax and National insurance payments self assesment. Please due and I confirm that I fully comply with the required Tax complete the regulations? information as appropriate. I confirm that I have already supplied/attached a copy of my Inland Revenue statement? Consent / Declaration signature

7 Passport photos Please affix two passport photos so we can use them for your ID card. Please affix two passport photos here Request for bank details Please complete the fields as appropriate. Agent Name Bank Name and address Postcode Account No Sort Code Account Name Declaration signature

8 Rehabilitation of offenders act 1974: Guidence notes for applicants. This legisla[on provides that, subject to certain exemp[ons, a person who has been convicted of a criminal offence and who has served their sentence becomes rehabilitated a_er a specified period and is not obliged to disclose past convic[ons. EXEMPTIONS There are certain convic[ons for which a person cannot become rehabilitated. These are: - - a sentence of imprisonment for life - a sentence of imprisonment, youth custody, deten[on in a young offender ins[tu[on or correc[ve training for a term exceeding 30 months - deten[on during Her Majesty s pleasure or sentence of custody for life - a sentence of preven[ve deten[on REHABILITATION PERIOD The length of [me that must elapse before a convic[on can be regarded as spent varies according to the nature of the convic[on as follows: In all these cases, the rehabilita[on period runs from the date of convic[on and not from the expiry of the sentence. CONVICTIONS DURING THE REHABILITATION PERIOD If another offence is commihed during the rehabilita[on period and the relevant sentence is not excluded from rehabilita[on, the period, which would end earlier, is extended to expire when the longer period expires. If the offence is subject to one of the sentences excluded from the Act, the offender will not become rehabilitated in respect of either convic[on. CONSEQUENCES OF NON DISCLOSURE A rehabilitated person is not obliged to disclose details of any previous convic[ons. However, failure to disclose convic[ons, which are not spent, will lead to your agency agreement being terminated. These notes are intended to provide a brief outline of how the 1974 Act can affect applicants. If you are s[ll unsure of your posi[on regarding rehabilita[on, please contact the Human Resource Department or a Ci[zen s Advice Bureau.

9 Required documents checklist Please ensure all the required docuemtns in this list are returned with your application. (missing required documents may delay the application process. UK Passport Passport must be valid. Driving Licence Must be a copy of the front and back of the Driving Licence. Proof of address Must be dated within three months. Public Liability Certificate Must be most recent and up to date. DBS check Must be most recent and up to date. **Please note that the cost of covering a disclosure certficate is your responsibility ICO/DPA registration certificate This will be needed to progress your application SIA Licence Evidence Qualification Evidence Such as Accident Investigation Certificates x 2 Passport Photos To be used for your ID card and file

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