CVS Cheshire East Payroll Services

Employee Information

This form is for allcurrent or new employees. Please complete in BLOCK CAPITALS

This form should be fully completed and returned to Kris Walton, CVS Cheshire East

Name of Organisation
Title
Forename(s)
Surname
Home Address
Post Code
Date of Birth
Gender / Male / Female (Delete as appropriate)
Marital Status / Single / Married / Divorced / Widowed / Partnered / Other
(Delete as appropriate)
National Insurance Number
Current Tax Code
Job Title / Description
Employment Start Date
Normal Working hours per week / month (please specify which)
Normal Working Days
(e.g. Mon - Fri)
Full-Time Salary per annum
Your Salary per annum
Hourly Rate of Pay (if applicable)
Pension Information
1. Are you a member of the Cheshire Pension Fund (Local Government Pension Scheme)? Yes / No (Delete as appropriate)
If yes:
Are you on NI Rate D (Contracted-out) Yes / No (Delete as appropriate)
If no:
Please give details of NI Rate A (Normal) or other NI Rate
2. Are you a member of another Pension Scheme? Yes / No (Delete as appropriate)
If yes:
Pension Provider
Type of Pension
With Tax Relief / Yes / No (Delete as appropriate)
Salary Sacrifice / Yes / No (Delete as appropriate)
Employers contribution
(Please state monthly amount or percentage of salary)
Employees contribution
(Please state monthly amount or percentage of salary)

Employee Statement

You need to select only one of the following statements A, B or C.

A Thisis my first job since last 6 April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension

B This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker’s Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a State or Occupational Pension

C As well as my new job, I have another job or receive a State or Occupational Pension

Do you have a Student Loan which is not fully repaid and all of the following apply:

. You left a course of UK higher education before last 6 April

. You received your first Student Loan instalment on or after 1 September 1998

NoYes

Signed / Date

The information requested on this form will only be used and stored in a manner that complies with the Data Protection Ac 1998 and all subsequent amendments