Step 1 of 3 33% Unique IDContact DetailsYour Name* Mr.Mrs.Miss.Ms.Dr.Prof.Rev. Prefix First Last Your Email* Mobile No:*Date of Birth* Day Month Year Your NI Number*If you do not have one copy this as an example aa123456a and we can discuss once you have submitted your application. Your Tax UTR* Your Home Address*Please enter your Home Address Street Address City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Contract DetailsRole/Job Title:*Enter your primary occupation. Your Hourly Rate*You current hourly or daily rate of payPlease enter a number greater than or equal to 9.Which Sector are You Working In?*Choose the sector(s) that best suits the area you will be working in. If you choose Other an additional field will load enabling you to specify another sector.ConstructionArchitectureDesign & Creative MediaEducationEngineeringFinancial ServicesHealthcareHealthcare Locums ?HospitalityProfessional ServicesRetailSales & MarketingScienceSocial CareIT & TechnologyOther (Please Specify)Other Sector NameYou will see this field because you are a Contractor and selected Other Sector in the previous field. Please enter here a short name for your sector. Your Contract Start Date*Your current or next Contract Start Date, if not certain your best estimate. DD slash MM slash YYYY Your Contract End Date*Your current or next Contract End Date, if not certain your best estimate. DD slash MM slash YYYY Agency Name*Your Contract: Agency Name (if applicable.) Your Next of Kin* Next of Kin Contact NoYour Bank DetailsBank details are needed to complete your application. We will send you a 2nd step request for this information which will be secured by your own private login and password. The information that will be required is specified below so that you can have the information ready to submit. CE+/CIS, subject to security issues and workflow rules.Bank Name* Account Holder Name* Bank Account No*Enter your 8 digit UK Bank Account Number here (numbers only field.) Bank Sort code*Please enter your 6 digit Bank Sort Code (Numbers only.) Your Personal Data and PrivacyPrivacyConsent to store and process your personal data*Your consent is needed in order to process and store personal data as part of your application and acceptance of your contract with Workr Group Limited. Please read our Privacy Notice which will be incorporated in to your contract. I confirm my consent for Workr Group Limited to store and process any personal data provided on this form in order to process my application and enter into this contract. I consent for you to store and process my personal data needed to enter into this contract. Consent for service product and marketing updates*Your optional consent is requested in order to be able to use your personal data provided to send you relevant service, product and marketing communications. I confirm my consent for Workr Group Limited to store and process any personal data provided on this form in order to send me relevant and appropriate marketing, sales and product or service information and communications, from time to time. Yes, I consent to this purpose No, I do not consent to this purpose Your Acceptance and ConfirmationThis section enables you to confirm that you have read and accepted the applicable terms and conditions for your Application. The fields displayed are specific to your application.» Self Employment+ Terms and ConditionsTerms and Conditions*1. I confirm that all the information supplied on this form is accurate and true to the best of my knowledge; 2. I have read, understand and accept the enclosed terms and conditions 3. I consent for all funds to be sent to the bank account noted above. If I am not the owner of this account then the account holder must also sign below to indicate their consent for funds to be sent to their account. Walker Smith cannot be held responsible for any breakdown in communication between you and the account holder once this form has been signed by both parties. I agree to the Terms and Conditions Date of Application*The date of your application will be the date at which you submit this form. DD slash MM slash YYYY Your Identity:ID MUST BE YOUR PASSPORT or BIRTH CERTIFICATE AND PROOF OF NI NUMBER. Upload Your Passport or Birth Certificate and NI Number LetterYou can upload a copy of your Passport or Birth Certificate and NI Number proof letter (files must be as a pdf,png or jpg file max file size 64mb)] IF YOU DO NOT HAVE A COPY TO HAND PLEASE SUBMIT BELOW AND WE WILL FOLLOW UP WITH YOU. Drop files here or Select files Accepted file types: pdf, jpg, png, jpeg, Max. file size: 64 MB, Max. files: 3. Your Nationality*If your Nationality is not listed, please select other and enter the correct Nationality. (*Required for ALL Applications)BritishAfghanAlbanianAlgerianAmericanAndorranAngolanArgentinianArmenianAustralianAustrianAzerbaijaniBahamianBahrainiBangladeshiBarbadianBelarusanBelgianBelizeanBenineseBhutaneseBolivianBosnianBrazilianBruneianBulgarianBurkineseBurmeseBurundianCambodianCameroonianCanadianCape VerdeanChadianChileanChineseColombianCongoleseCosta RicanCroatianCubanCypriotCzechDaneDjiboutianDominicanDominicanDutchEcuadoreanEgyptianEnglishEritreanEstonianEthiopianFijianFilipinoFinnFrenchGaboneseGambianGeorgianGermanGhanaianGreekGrenadianGuatemalanGuineanGuyaneseHaitianHonduranHungarianIcelanderIndianIndonesianIranianIraqiIrishItalianJamaicanJapaneseJordanianKazakhKenyanKuwaitiLaotianLatvianLebaneseLiberianLibyanLiechtensteinerLithuanianLuxembourgerMacedonianMadagascanMalawianMalaysianMaldivianMalianMalteseMauritanianMauritianMexicanMoldovanMonégasque or MonacanMongolianMontenegrinMoroccanMozambicanNamibianNepaleseNew ZealanderNicaraguanNigerienNigerianNorth KoreanNorwegianOmaniPakistaniPanamanianPapu New GuineanParaguayanPeruvianPolishPortugueseQatariRomanianRussianRwandanSalvadoreanSaudi ArabianScottishSenegaleseSerbianSeychelloisSierra LeonianSingaporeanSlovakianSlovenianSolomon IslanderSomaliSouth AfricanSouth KoreanSpaniardSri LankanSudaneseSurinamer or SurinameseSwaziSwedeSwissSyrianTaiwaneseTajikTanzanianThaiTogoleseTrinidadianTobaganTobagonianTunisianTurkishTuvaluanUgandanUkrainianUruguayanUzbekVanuatuanVenezuelanVietnameseWestern SamoanYemeniYugoslavZaïreanZambianZimbabweanCommentsThis field is for validation purposes and should be left unchanged.