Private and Confidential
Monthly Salaries Payroll (SAL)
PERSONAL RECORD FORM
Please note it will not be possible to process payments without this form.
Please complete ALL sections in BLOCK CAPITALS.
Employee
Number
Department
Title
Surname (as official documents)
Forename (s) (as
official documents)
Preferred Forename
Home Address
Please note your address
May be passed onto your
Department for their records
Post Code
Telephone No
Date of Birth
Start Date
Mobile No
D D
M
M
Y
Y
D D
M
M
Y
Y
National
Insurance No
Gender
A
M
A
N
F
N
N
N
N
N A
Please tick as
appropriate
Payment Details – All payments are made by BACS
Sort Code
-
-
Name of Bank
_________________________________________________________________
Account Number
Bank Branch
_______________________________________________
Account Name
Bank Address
_________________________________________________________________
Building Society
Roll Number
Emergency Contact Details (Please provide details to be used in case of emergency)
Contact Name
Telephone No
Mobile No
Please note this information may be passed to your department but will only be used in the event of an emergency
I confirm that the personal information given on this form is correct. I also agree that in the event of overpayment of any salary or
other remuneration, the University is entitled to make the relevant deduction from any subsequent payment(s). The University will
let you know and agree in advance the relevant deduction, but its failure to do so will not affect its right to reclaim the overpayment.
Signed_________________________________
Date__________________________________________
OFFICE USE ONLY - HR ASSISTANT
PSe Updated
Actioned by _______________________ Date ______________
Changes made to form and reason(s) why, between receipt in HR and forwarding to Payroll
Initial ________ Date _________
Personal Record Form
Employee
Number
Department
Surname (as official documents)
Taxation Status – Please confirm your current circumstances
Please read all of the statements carefully and enter X in the ONE box that applies to you
A
This is my first job in the current tax year (6 April onwards). I have no other forms of income and I do not receive a pension or state
benefits.
B
I have received taxable Job Seekers Allowance, Incapacity Benefit, Employment and Support Allowance or this is not my first job in the
current tax year (6 April onwards). However, this is now my only job or main (highest earning) job. I do not receive a state or
occupational pension.
C
This is a secondary position (i.e. I work for another organisation excluding Unitemps ) or I am in receipt of a state pension .
D
I have been employed by Unitemps in the current tax year (6 April onwards). If you have ticked this box you MUST tick ONE additional
statement below
I no longer wish to be employed by Unitemps. (NB Your Unitemp role will be closed down and a P45 will be issued to your new
University post.) (Payroll – advise Unitemps agency employee made to leave.)
I am still engaged with Unitemps and I wish Unitemps to be my main source of income.
I am still engaged with Unitemps and I wish the University to be my main source of income. NB you will need to contact
HMRC to change your tax code tel 0845 3000627. UOW tax reference – 190/050, Unitemps tax reference 120/ZA76059. Until
confirmation is received you will be taxed at basic rate, currently 20%, with no allowance.
If no statements apply then tax will be deducted on code 0T month 1
Student Loan – Please confirm you current circumstances
Please read the following statement carefully and enter X in the box if this applies to you
I left a course in Higher Education before the current tax year (prior 6 April) and received my first Student Loan instalment on or after 1
September 1998 and I have not fully repaid my Student Loan. (If you are required to repay your Student Loan through your bank/building
society account DO NOT enter an X in this box.
I confirm that the personal information given on this form is correct. I also agree that in the event of overpayment of any salary or
other remuneration, the University is entitled to make the relevant deduction from any subsequent payment(s). The University will
let you know and agree in advance the relevant deduction, but its failure to do so will not affect its right to reclaim the overpayment.
Signed_________________________________
Date__________________________________________
OFFICE USE ONLY – PAYROLL ASSISTANT
PSe Updated
Actioned by _______________________ Date ______________
Changes made to form and reason(s) why, between receipt in HR and forwarding to Payroll
Initial ________ Date _________
March 2016 V8
PENSION INFORMATION
Employee
Number
Department
Surname (as official documents)
With effect from 1 March 2013 the University of Warwick is required to comply with government legislation to automatically enrol eligioble workers
into an occupational pension scheme. This process is called auto enrolment. Your offer of employment will outline your eligibility for one of the
University’s pension schemes. Details of the scheme and the associated salary sacrifice scheme (PensionsPlus) were included with your offer
letter.
Please complete the relevant sections below, it would be of assistance if you could also indicate whether you have transferable provision from
another USS or NHS Scheme.
Request to Join a Scheme
I wish to enrol in the appropriate pension scheme for my grade. I confirm I personally submit this notice to join a workplace
pension scheme.
Universities Superannuation Scheme (USS)
My pension’s letter indicates that I am entitled to USS membership.
I am a member of the Final Salary section of USS.
I was a former member of the Final Salary section of USS.
I will be a new member of USS.
University of Warwick Pension Scheme (UPS)
My pension’s letter indicates that I am entitled to UWPS membership.
I wish to make the following contributions into UPS and I have completed the appropriate joining form to indicate the funds that I wish my money to
be allocated. If you do not select a percentage you will be enrolled at the default rate (currently 1%).
Contribution Level: Please tick the appropriate box for the level of contribution that you wish to make
1%
2%
3%
4%
5%
NHS Pension Scheme
My offer letter indicates that I am entitled to membership of the NHS pension scheme
I have contributed to the NHS pension scheme for the last 12 months and have completed the appropriate form.
I have previously paid NHS AVC’s.
PensionsPlus (for all schemes)
I confirm that I wish to join PensionsPlus, which I understand is a salary sacrifice scheme
I wish to opt out of PensionsPlus. (NB You are required to complete a form if you wish to opt out of PensionsPlus.)
Marital Status
If you choose to join a pension scheme, please indicate your marital status by ticking one of the following boxes
Civil Partner
Civil Widow/Widower
Single
Widowed
Dissolved
Divorced
Married
Separated
Opting Out of a Pension Scheme
Although the University is required to automatically enrol qualifying staff into a pension scheme, you have the right to opt out. However, to opt out
you must obtain a form from the pension provider. You will not be excluded from the pension scheme until we receive your signed opt-out form,
please refer to your offer letter for more information.
Signed_________________________________
Date__________________________________________
OFFICE USE ONLY - PENSIONS
Auto enrolment into scheme
USS FS
USS CRB
UPS Heritage
UPS Enterprise
Personal choice scheme
USS FS
USS CRB
UPS Heritage
Pensions Administrator ____________________________
UPS Enterprise
NHS
Date _____________________
March 2016 V8
Employee
Number
Department
Surname (as official documents)
EQUALITY AND DIVERSITY
The University is required to collate and report on equality and diversity information.
In order for us to comply with this requirement could you PLEASE CIRCLE the entry that best describes your ethnicity.
10 White
32 Asian/Asian British-Pakistan
43 Mixed-White and Asian
15 Gypsy or Traveller
33 Asian/Asian British-Bangladesh
49 Other Mixed Background
21 Black/Black British-Caribbean
34 Chinese
50 Arab
22 Black/Black British-Africa
39 Other Asian Background
80 Other Ethnic Background
29 Other Black Background
41 Mixed-White and Black Caribbean
98 Prefer Not to Say
31 Asian/Asian British-India
42 Mixed-White and Black African
Religion
What is your religion?
No religion
Jewish
Any other religion or belief
Buddhist
Muslim
Prefer not to say
Sexual Orientation
What is your sexual orientation?
Bisexual
Gay man
Other
Prefer not to say
Christian
Sikh
Gay Woman/Lesbian
Please enter your
nationality below
Hindu
Spiritual
Heterosexual/Straight
Disability
The Equality Act 2010 states that a disabled person is someone who has a physical or mental impairment which has a substantial, adverse and
long-term (usually 12 months or greater) effect on their ability to carry out their day to day duties. If your impairment would have a substantial effect
on you without medication then this part of the definition would be satisfied (this excludes glasses or contact lenses). Please note that cancer, HIV,
multiple sclerosis, are automatically classed as a disability from the day of diagnosis.
This information is confidential, however, in order to ensure that appropriate reasonable adjustments and support are in place to assist you in your
role, do you agree to meet with your line manager and HR Adviser for your department to discuss support
mechanisms.
Yes No
If responding Yes, a meeting will be organised by the HR Adviser for your department.
Do you have a disability?
Y
N
If Y, PLEASE CIRCLE below, as appropriate.
The University is required by the Higher Education Statistics Agency (HESA), to collect information from staff on the nature of their disability. The
following list has been drawn up by HESA and provided to all universities to ensure consistency of data collection. If you indicated Yes to the
disability question above, please select at least one disability from the options below.
Blind or serious visual impairment
Mental health condition (eg depression or schizophrenia)
Cognitive impairment (eg autistic spectrum disorder or resulting from a
Other type of disability
head injury)
Deaf or serious hearing impairment
Physical impairment or mobility (eg use of arms or using a wheelchair
Specific learning disability (such as dyslexia or dyspraxia)
or crutches)
Prefer not to say
General learning disability (such as Downs syndrome)
Long-standing illness (eg diabetes, epilepsy, cancer, HIV, or chronic
heart disease)
March 2016 V8
HESA DATA
As part of its statistical reporting the University must make annual returns to HESA (Higher Education Statistics Authority). To assist in the reporting
of this data could you PLEASE CIRCLE below the statement that applies to you
Previous employment before Warwick – Please circle the entry that describes your previous employment status
01 Another Higher Education Institute in the UK. Please provide the name of the institution:
02 HEI in an overseas country
07
Student in UK
12
Private industry/commerce in UK
03 Other education institution in UK
08
Student in an overseas country
13
Self-employed in UK
04 Other education institution in an
09
NHS/General medical or dental practice in the
14
Other employment in UK
overseas country
UK
05 Research institution in UK
10
Health services in an overseas country
15
Other employment in an overseas
country
06 Research institution overseas
11
Other public sector UK
21
Not in regular employment
PLEASE CIRCLE the entry that relates to your highest qualification
01
02
03
09
11
12
19
21
22
29
31
32
97
98
Doctorate
Other Higher Degree
PGCE
Other Postgraduate Qualifications (in professional)
First Degree
First Degree with Qualified Teacher Status (QTS)
Other qualifications at first degree level inc
professional
Diploma of HE
HND/HNC
Other undergraduate qualification (inc professional)
A level, Scottish Higher or equivalent (NVQ/SVQ 3)
O level /GCSE or equivalent (NVQ/SVQ 2)
Other qualifications
No qualifications
Academic teaching qualification - Please state if you have
any teaching qualifications or have been recognised in other
ways for your teaching experience regardless of your current
position.
_____________________________________________
Current academic teaching discipline 1 – If you will be doing
teaching or doing research work, please indicate the
academic discipline that covers your primary subject area.
______________________________________________
Current academic discipline 2 – If you will be working in more
than one subject area, please indicate the secondary
discipline here.
________________________________________________
March 2016 V8
Guidance to the Personal Record Form Data Collection
When completing your personal details on the personal record form you need to ensure that your names are written
as they appear on official documentation eg passport. This is to ensure that our records comply with HMRC
regulations.
The University is proud of its diverse community, students and visitors, and is committed to maintaining its excellent
record in teaching and research by ensuring there is equality of opportunity for all, fostered in an environment of
mutual respect and dignity. The University takes steps to ensure that all data is treated sensitively and will not be
revealed to third parties. The University is committed to equality and diversity and requires information to comply with
its legal obligations, evaluate its single equality scheme and ensure that the needs of individuals are met. We are also
required, by the Higher Education Statistics Agency (HESA), to collect information from all staff on the nature of any
disabilities. The lists on this form have been drawn up by HESA and provided to all universities to ensure consistency
of data collection.
Please note that this data is confidential and will be used for monitoring purposes only. If you have a disability and
require any adjustments or have other queries, please contact your manager or your link Human Resources Adviser.
New Starters should complete the Personal Record Form (included the HESA information) and then submit the form
to their Departmental Administrator who will submit the form to payroll.
March 2016 V8