Confidential
Tendering for the supply of Self-Employed Contracted Services to
Cleshar Contract Services Limited
Tender Form
Please complete this form in block capitals using black ink. (*delete or circle as appropriate). If your tender is accepted you will be required to sign a
contract before you start.
PERSONAL DETAILS
Title
First Names
Surname
Initials
Home Address
Date of Birth
Postcode
Nationality
Trade
Telephone
Mobile
Fax
E-mail
Gender
Dates NOT available for assessment
Date available to start contract
Have you applied to [Cleshar Contract Services Limited] before?
YES / NO*
/
/
Do you understand that you will be self-employed?
YES / NO*
ALL CONTRACTED SERVICES ARE PROVIDED ON A SELF-EMPLOYED SUBCONTRACTOR BASIS
Do you currently hold a full clean driving licence?
Are you registered as self-employed with Inland Revenue?
Have you ever had any alcohol or drug dependency?
YES / NO*
Evidence of Identification
Passport:
IND Papers:
Birth Certificate:
Unique Tax Reference Code:
YES / NO*
YES / NO*
National Insurance Number
Are you eligible for employment in the UK?
YES / NO*
Do you suffer from any illness or medical condition, which
may be relevant to the supply of your services?
If YES please give brief details
YES / NO*
Have you ever been convicted of a criminal offence which
is not spent under the Rehabilitation of Offenders Act 1974?
If YES please indicate outcome
YES / NO*
Please indicate any family connection or similar contact at [Cleshar Contract Services Limited] (names):
In the last year, how many days have you been unable to provide services as a result of illness?
FOR OFFICE USE ONLY
Explained no provision of services until proved ……….
Self-Employed Subcontractor – Tender Form – January 2004
Copy of UTR taken……….
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801(02)F
Please indicate which current certificates you hold
CERTIFICATION
Fire Awareness
Fire Watchman
Track Accustom
First Aid
PTS
PICOW
Protection Master EH
Entry Permit
Protection Master TH
SPIC
Trolley
PTS
IWA
COSS
PREVIOUS EXPERIENCE
Please list any employment or self-employed services you have provided which is relevant to your application for this tender. Include full-time (FT) and
part-time employment (PT).
Dates
Employer/Contractor
Title
Responsibilities/Duties
Education
Reason for
Salary/income
Leaving/
on leaving/
Termination
Termination (£)
of contract
Please use this space to explain periods, which are unaccounted for.
Dates
Activity
Before completing this section, please state whether have you read the full services descriptions for this tender (please answer freely)
YES / NO
Please explain and provide evidence of your suitability for this tender
Self-Employed Subcontractor – Tender Form – January 2004
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801(02)F
REFERENCES
Please provide the names and addresses of two referees from your previous employer or customer who are not related to you, but know you well. One of
these should be your present or most recent employer/customer. If you are currently in or have recently left full time education, then please also provide an
academic referee.
EMPLOYMENT/CUSTOMER REFEREE
EMPLOYMENT/CUSTOMER REFEREE
ACADEMIC REFEREE
Name
Name
Name
Address
Address
Address
Postcode
Postcode
Postcode
Telephone
Telephone
Telephone
Occupation
Occupation
Occupation
Relationship
Relationship
Relationship
Please indicate whether [Cleshar Contract Services Limited] may contact your referees prior to assessment:
YES / NO
YES / NO
YES / NO
MONITORING
[Cleshar Contract Services Limited aims to provide equal opportunities and monitors tenders to ensure that its selection/appointment procedures are
fair. To assist this process please complete the section below. Any information you give under this section is for monitoring purposes only and will not
form part of any decision. Write here the source of your tender (e.g. advertisement, college careers service, personal recommendation [by whom?]
etc):
....................
Publication/date (if any) . . . . . . . . . . . . . . . .
Do you consider yourself to be a disabled person?
YES / NO*
Introduced by . . . . . . . . . . . . . . . . . . Other: . . . . . . . . . . . . . . . . . . . .
Where did you learn of Cleshar Contract Services Limited?
If registered under the Disabled Persons
Friend /relative
Careers Service
(Employment) Act, please state registration number
Advertisement
Student directory
Agency
Other
Which of the following best describes your ethnic origin? (please tick)
Please indicate your marital status
White
Asian
Single
Married
Black Caribbean
Oriental
Divorced
Separated
Black African
Other
Please Specify
Widowed
Other
DECLARATION
Should I be awarded a contract for services with Cleshar Contract Services Limited, I understand that it will be on the basis that the details on this form
and all other documentation such as supplementary questionnaires and any others supplied by myself and all verbal statements made by me during the
tender process are true. I understand that any offer for sub contractor work is subject to receipt of satisfactory references and a successful medical
assessment.
The Data Protection Act 1998 Information provided by you on this tender form may be copied for use during the tender process. Once the assessment
procedure is completed, the data will be stored for at least six months and then destroyed. If you are successful, relevant information may be taken from
this form and used as part of your contract for services record.
Self-Employed Subcontractor – Tender Form – January 2004
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801(02)F
I AUTHORISE CLESHAR CONTRACT SERVICES LIMITED TO TAKE COPIES OF ALL NECESSARY DOCUMENTS IN
ORDER TO SATISFY LEGISLATIVE AND ADMINISTRATIVE REQUIREMENTS AND TO KEEP THE COPIES OF THESE
DOCUMENTS IN THEIR FILES.
SIGNED
DATED
/
/
I FULLY UNDERSTAND THAT MY STATUS WITH CLESHAR CONTRACT SERVICES LIMITED WILL BE THAT OF A
SUBCONTRACTOR PROVIDING SERVICES ON A SELF-EMPLOYED BASIS AND NOT AS AN EMPLOYEE AND THAT
[CLESHAR CONTRACT SERVICES LIMITED] WILL HAVE NO OBLIGATION TO PROVIDE ME WITH WORK AND I
WILL HAVE NO OBLIGATION TO PROVIDE MY SERVICES. I FURTHER UNDERSTAND THAT ANY CONTRACTED
SERVICES CAN BE PROVIDED BY A SUITABLY QUALIFIED REPLACEMENT.
SIGNED
DATED
/
/
Please return this form to:
The Subcontractor Coordinator, Cleshar Contract Services Limited, Heather Park House, North Circular Road, Stonebridge, London NW10 7NN
Self-Employed Subcontractor – Tender Form – January 2004
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801(02)F