New PA/Carer (Employee) Form Section 1 to be completed by the client (the employer) – Title (please circle) Forename/s Surname Mr Miss Local Authority Customer Leicester the (Employer) About Other (please specify)……………………………………………………… Employee’s Start Date Weekly Live In Rate (£) Pay Weekday Rate (£) Weekend Rate (£) Bank Holiday Rate (£) of Overnight Shift Shift Hour Shift Rates Working Days Employee Mon Tue Wed Thu Fri Sat Sun Section 2 to be completed by the PA/carer (the employee) – (please circle) Forename/s Surname Mr Mrs Ms Address (Including Postcode) Details Date of Birth (employee) If you are of pensionable age please enclose National Insurance No. (if applicable) of your age (e.g. copy of passport, PA/Carer driving licence etc) Yes No
New PA/Carer (Employee) Form Section 1 – to be completed by the client (the employer) About the Customer (Employer) Title (please circle) Forename/s Surname Mr Miss Local Authority Leicester Other (please specify)……………………………………………………… Employee Rates of Pay Employee’s Start Date Weekly Live In Rate (£) Weekday Rate (£) Weekend Rate (£) Bank Holiday Rate (£) Overnight Shift Shift Hour Shift Working Days Mon Tue Wed Thu Fri Sat Sun Section 2 – to be completed by the PA/carer (the employee) PA/Carer (employee) Details (please circle) Forename/s Surname Mr Mrs Ms Address (Including Postcode) Date of Birth National Insurance No. (if applicable) If you are of pensionable age please enclose of your age (e.g. copy of passport, driving licence etc) Yes No
New-PA-Carer-Employee-form-Leicester.docx