CASUAL WORKER NEW STARTER FORM
Date sent to payroll / For USS purposes: Date of Birth Verification sent to Payroll

This form is to be used to instruct payroll on the details of any new starters.

TO BE COMPLETED BY EMPLOYEE – PLEASE READ BELOW

1.  Please complete all information in section 1 in BLOCK CAPITALS, SIGN and date the declaration.

2.  Return this form to Human Resources Department, Keele University, Keele, Staffordshire, ST5 5BG.

SECTION 1 – TO BE COMPLETED BY CASUAL WORKER

Surname:

/

Forenames

Title: / Gender: / Date of birth / National Insurance Number
Home Address: / Next of Kin’s Name and Address:
Postcode: / Postcode:
Contact Telephone Number: / Next of Kin’s Contact Telephone Number:
Passport number / Alternative eligibility checks / Yes No
Do you require a certificate of sponsorship or visa to live/work in the UK / Yes No / Are you currently registered as a student at Keele University. / Yes No
Do you currently undertake paid work for the University (i.e. as an employee or casual worker) / Yes No / If yes, please provide your Keele Student ID
Bank Account Number: MUST BE COMPLETED IN ALL CASES / Sort Code: MUST BE COMPLETED IN ALL CASES
0

Building Society Account Number:

Bank Name and Branch
SECTION 1 CONT’D – TO BE COMPLETED BY CASUAL WORKER
Starter Declaration
To ensure that you pay the correct amount of tax, and make any required Student Loan repayments please read all the following statements carefully.
Please attach your P45 if you have one.
If you do not attach a P45 you MUST complete the Starter Declaration details below. Enter ‘X’ in the one box that applies to you
A / This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit or a state or occupational pension. OR
B / This is now my only job, but since last 6 April I have had another job, or have received taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive a state or occupational pension. OR
C / I have another job or receive a state or occupational pension.
D / Student Loans: If you left a course of Higher Education before last 6 April and received your first Student Loan instalment on or after 1 September 1998 and you have not fully repaid your Student Loan, enter 'X' in box D. (If you are required to repay your Student Loan through your bank or building society account do not enter an 'X' in box D.)
I confirm that all the information given above in Section 1 is correct.
Signed: / Date:

SECTION 2 - TO BE COMPLETED BY PAYROLL

Payroll No: / Department Code: / Budget Code:
P45 Gross / P45 Tax / Tax Code / Mth 1 / NI Scheme / Super Code
Payflex+ / Superann. Date / Grade / Point / Sick Code / Cas / F/P Time / Pers Rate
_ / _ / 9 / 9 / Y / P / 0


Prepared by: / Verified by:
Date: / Date: