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Emergency Contact Information

Medical / Important Information (optional)

Social Media / Image Consent Form

I consent to my image / photo being used for internal company purposes
Yes
No
I consent to my image / photo being used for external company purposes including social media
Yes
No
I consent to video recordings being used for internal training or promotional purposes
Yes
No
I consent to my first name and job title being included alongside images where appropriate
Yes
No
I understand that I must not post confidential company, staff or service user information on social media
Yes
No
I understand that I must follow the company social media policy at all times and not post anything about or towards the business without permission
Yes
No
I understand that after I leave JKL Care I must still maintain service users confidentiality and not contact or post about service users
Yes
No
I agree to not post malicious content and maintain professional towards JKL during and after service
Yes
No
I understand that any breach of confidentiality or professional boundaries may lead to disciplinary action
Yes
No

Working Time Regulations 1998 48-Hour Opt-Out Agreement

Please note: this agreement is not suitable for apprentices or workers under the age of 18 years.

Dear Employee,

Under the Working Time Regulations 1998, a worker’s average weekly working time, including overtime, must not normally exceed 48 hours per week, calculated over a rolling 17-week reference period.

The Regulations allow an employee to voluntarily agree in writing that this limit will not apply.

By signing this form, you are confirming that you agree to opt out of the 48-hour weekly working limit and understand that you may work more than an average of 48 hours per week.

This agreement is entirely voluntary.

You may withdraw your agreement at any time by providing the Company with three months’ written notice, unless otherwise agreed in writing.

Please confirm your agreement by signing below.

Employee Agreement

I agree that the limit specified in Regulation 4(1) of the Working Time Regulations 1998 shall not apply in my case.

I understand that this agreement is voluntary and that I may withdraw my consent by giving the required written notice.

Employee Declaration

I voluntarily agree that the 48-hour average weekly working time limit shall not apply to my employment with JKL Care Services.

I understand that:

  • this agreement is voluntary

  • I am not required to sign this form

  • I may withdraw my agreement by giving written notice

  • the notice period for withdrawal will be 1 month.

  • all other rest breaks and working time protections remain in place

Leave blank if you wish to remain under the working time directive

I voluntarily agree that the 48-hour average weekly working time limit shall not apply to my employment at JKL.
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Employee Health Questionnaire Care Services Pre-Employment Health Declaration

Please return this form to management when completed.

This questionnaire is designed to help the employer meet legal health and safety duties, assess whether there are any health issues likely to affect your employment, and identify whether any support or workplace adjustments may be required.

All information provided will be treated as strictly confidential and will only be accessed by authorised personnel.

Please answer all questions truthfully.

Heart Condition / Blood Pressure Concerns
Respiratory condition / Asthma
Diabetes
Epilepsy / Seizures / Blackouts
Dizziness / Fainting Episodes
Anxiety, Stress, Depression or other Mental Health Condition
Allergies / Skin Reactions
Hearing Difficulties
Vision Difficulties
Current medication that may affect work

Physical Capability for Care Duties

Any Back / Neck / Joint conditions
Difficulty with Moving and Assisting Tasks
Difficulty Standing / Walking for long Periods
Any issue affecting personal care support tasks
Any Issue affecting driving for work

Infection Control / Workplace Exposure

Any conditions affecting PPE use
Skin Condition affected by gloves / handwashing
Any Known Infectious diseases concerns

Absence / Medical History

Any illness / injury causing more than 3 months off work
Left previous employment for health reason
Frequent sickness absence in the last 12 months

Support and Adjustments

Require any support or workplace adjustments
Wish to discuss any health concerns confidentially

GP Details

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Pension / NEST Information Notice Workplace Pension Information

Dear Employee,

Soon we will be automatically enrolling you into NEST.

Workplace pension law requires us to enrol eligible employees into a workplace pension scheme that meets legal standards.

We have chosen NEST as our workplace pension provider to meet our employer duties and to help you save for your retirement. NEST provides one retirement pot for life.

You will be automatically enrolled into NEST. If you wish to remain in the scheme, you do not need to do anything.

If you would like to know more about NEST, please visit:


www.nestpensions.org.uk

Once enrolled, you will receive your welcome pack and be able to activate your online account.

 

Contributions to Your NEST Retirement Pot

We will make employer contributions to your retirement pot and you will pay employee contributions.

If eligible, you may also receive tax relief from the government through the relief at source method.

This means that your pension contributions are made from your pay after tax, and NEST claims the tax relief from HMRC and adds it to your pension pot.

If you pay tax at a higher rate, you may be able to claim additional tax relief through Self-Assessment.

Contributions are based on your qualifying earnings, which may include:

  • basic salary

  • overtime

  • bonuses

  • sick pay

  • taxable earnings

 

Contribution Rates


Employer contribution

3%

Employee contribution

5%

Tax relief

20%

 

Opting Out

If you decide that you do not wish to remain in the pension scheme, you have the right to opt out.

The opt-out period is normally one month from the date your enrolment begins.

You cannot opt out until you have been enrolled and received your NEST ID / welcome pack.

Once you receive your NEST ID, you may opt out by:

  • completing the NEST online opt-out

  • contacting NEST directly

  • completing the internal opt-out request form

If a valid opt-out request is received, any contributions already deducted will be refunded through payroll.

 

Re-Enrolment

If you opt out, you may be automatically re-enrolled at a later date, usually every three years, in line with legal requirements.

You may also request to opt back in at a later date.

 

Further Information

NEST


Nene Hall


Lynch Wood Business Park


Peterborough


PE2 6FY

Website: www.nestpensions.org.uk


Member enquiries: 0300 020 0090

For general pension information:


www.gov.uk/workplace-pensions

Yours sincerely,


JKL Care Services

 

 

Pension Opt-Out Acknowledgement Form

(Leave Blank if you wish to enrol in Nest Pension)

Date
Month
Day
Year

Important Information

I confirm that I have been automatically enrolled into the Company’s workplace pension scheme.

I understand that:

  • I have the right to opt out within the permitted opt-out period after receiving my enrolment details

  • If I choose to opt out, employer contributions will stop

  • No further pension contributions will be made unless I choose to opt back in at a later date

  • Opting out may affect my future pension benefits

Opt-Out Confirmation

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