DSV Haldens

Form 3 of 3

Next Step (Form 3)
Assignment Details Form
Details of the Employee
Forename(s)*
Surname*
Address
Street Address Line 2 City / Town County Postcode Country
Details of the Hirer
Name of the Hirer*
Nature of the Hirer’s business*
Name of Hirer’s contact to report to on arrival*
Report to Gatehouse on arrival, follow instructions provided Siamo
Assignment Details
Likely duration of the Assignment*
Calendar weeks already accrued towards the Qualifying Period for the purposes of Regulations 7 and 8 of the Agency Workers Regulations 2010*
The type of work*
Location of work*
Hours of work*
06:00-14:00 / 08:00-16:00 / 14:00-22:00 / 22:00-06:00 (plus flex), Monday - Friday working pattern with weekend overtime. (Hours subject are subject to change as per operational requirements)
The experience, training, qualifications and any authorisation necessary or required by law or a professional body*
Must be over 18 years of age; Relevant certification (ITSSAR, RTITB, AITT), site assessment & approval required for operation of MHE; Site/H&S Induction; Job relevant training given
Any known health and safety risks and the steps the hirer has taken to reduce the risks*
Health & safety + site/general induction + manual handling & pump truck training covered during induction. PPE must be worn at all times (safety boots, hi viz vest)
Collective Facilities
Hirer’s collective facilities available*
Canteen, Lockers (workers need their own padlock) Free car park
Pay
Any expenses payable*
Actual Rate of Pay*
AM - £9.75 PM - £9.75 + £1 shift allowance Nights - £9.75 + £2 shift allowance
Intervals of Payment*
Annual Leave
Number of additional [paid/unpaid] annual leave days payable on completion of QP*
Contacts

Your Recruitment Consultant contact details:
Your Recruitment Manager contact details*
Beth Jones 07970 404 752 (24/7)
AUTHORISATION FOR DEDUCTION FROM SALARY

Access Card

Terms & Conditions of deduction

I can confirm that I authorise for Siamo Group to take £5 out of my wages to cover the cost of the replacement Access Card if not returned within 3 working days after the assignment is ended.

I have read and understand the above terms and conditions for potential deductions regarding the Access Card.

I hereby authorise a deduction of £5 direct from my salary if not returned in the stipulated time.
Signature*
Forename(s)*
Surname*
Date*
DD slash MM slash YYYY
Hidden
Sharepoint Email
Hidden
Branch Number
Hidden
Client/Site Name

Need assistance?
Call 0116 233 4404

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DSV Haldens

Assignment Details Form

Details of the Employee

Details of the Hirer

Assignment Details

Collective Facilities

Pay

Annual Leave

Contacts

AUTHORISATION FOR DEDUCTION FROM SALARY

Access Card

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