Are you a carer looking for work?

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Employee Details

Full Name*

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Address and Postcode

Date of Birth

Contact Number

Marital Status

National Insurance No:

Contact Number:

E-mail

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Start Date:

Please tick all relevant statements.

A - This is my first job since last 6 April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.

B - This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker’s Allowance, Universal Credit, Employment and Support Allowance, taxable Incapacity Benefit.

C - I do not receive a State or Occupational Pension.

D - As well as my new job, I have another job or receive a State or Occupational Pension.

I agree the above details are correct (Insert Name)

Date

I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

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Employer Details

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Contact us

Telephone: 01706

E-mail: info@integrateindependence.co.uk