1. Title *
2. First Name(s) *
3. Surname *
4. Address 1 *
5. Address 2
6. Town/City *
7. County *
8. Postcode *
9. Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Yugoslavia Zambia Zimbabwe
10. Telephone
11. Mobile *

1. Email Address *
2. Date of Birth * 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 01 02 03 04 05 06 07 08 09 10 11 12 / 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930
3. Town of Birth *
4. Nationality *
5. Job Title *
   (and Band if known)
6. National Insurance No.
7. Tax Code
8. Rate *

1. Bank Name *
2. Name as it appears on account *
3. Account Number *
4. Branch Sortcode *
5. Building Society Roll Number

1. Branch Address
2. Branch Postcode

1. Agency Name *
2. Agency Contact (Fullname) *
3. Telephone *
4. Fax
5. Email

1. Address *
2. Postcode *

I hereby confirm that Argentia may contact the above named Agency/ End-Client with my consent, and that the above named Agency/ End-Client is hereby authorised to release and/ or discuss my personal data/ records held on their files for the purpose of Argentia completing the necessary arrangements to take over my current contract with that Agency/ End-Client and/ or for the purpose of collecting data relating to my previous work/ employment history from that Agency/ End-Client.

1. Online Signature *

YOU MAY OMIT THIS SECTION IF YOU ARE SENDING IN A FULL CURRICULUM VITAE, LISTING SKILLS, QUALIFICATIONS & PREVIOUS WORK HISTORY

1. Skills
2. Work Employment: From - To
3. Name & Address of Client/Employer
4. Job Title & Duties

1. Qualifications
2. Reference 1 - Work Experience
3. Reference 2 - Character

1. Mother's Maiden Name *

1. Father's First Name *

*FORM P45/P46 (PLEASE DELETE AS APPROPRIATE BY STRIKING THROUGH THOSE THAT DO NOT APPLY)
*Form P45 from my previous employer is attached/ enclosed with this form
*Form P45 from my previous employer will be sent later
*I am unable to obtain a P45. I request that Form P46 be provided to me

IDENTIFICATION & ENTITLEMENT TO WORK IN THE UNITED KINGDOM

Argentia is required to verify your identification and right to work in the United kingdom in advance, and to retain this data on our files.

You may either provide us with original documents that we will copy and return to you, or you may take the documents to one of the following professional persons, or person of equivalent standing, for certification of copies.

Lawyer
Accountant
Notary Public
Police Officer

Certification must be in the following form:

"I certify that this is a true copy of the original document which I have seen, taken at [ADDRESS] on the [DD] day of [MONTH] 200[Y]."

The certifier must sign, stating his or her occupation and/ or professional qualification.

A provisional offer to join Argentia may be made whilst your documentation is in process, but will not be confirmed to you in writing until such documentation has been received.

1 Document from each of the following lists is required

LIST A

Signed, current passport
EEA Employee State Identity Car
Residence permit issued to EEA nationals by UK Home Office
Current full UK driving licence
National Identity Card containing your photograph

LIST B

Recent utility bill no more than 3 months old
Bank statement no more than 3 months old
Confirmation from the electoral register that you are registered at your address

If you were referred to Argentia by an existing member of Argentia please provide their name below to ensure that they are rewarded through our Loyalty Reward Points program if you are successful in your application with Argentia.

2. Referrers Name

I confirm that I am applying to join Argentia, and that the information here given is true and correct.

I understand that the Company will use my personal data for employment administration, payroll, administrative and customer services purposes, and authorise its provision to employees and agents of the Company for these purposes in accordance with the Data Protection Act 2003. You are entitled to request a copy of your personal data held on our files at any time.

1. Online Signature *