Lycon Recruitment will collect and process personal data from you, which may include sensitive personal data, for the purpose of carrying out its business of supplying temporary and permanent workers to clients and in order to find you suitable assignments. The company may also collect personal data about you from third parties, such as referees and third party agencies, in order to verify information such as professional qualifications and educational background. We may disclose your personal data to clients for the purposes of an assignment/ potential assignment or periodic review. You will also be consenting to the transfer of essential information to our agents, our clients and the criminal records bureau for the purpose of a criminal records disclosure application. You hereby consent to us collecting and processing your personal data and disclosing this information to clients and other relevant third parties for the purposes outlined above. If you terminate this contract or enter in to new terms of engagement with a different organisation, in circumstances where you continue to work for the same client, we may disclose your personal information to the new organisation at the client’s request.

1. Do you agree with the statements above *

2. Date *

3. Signature  *

1. Lycon Recruitment are committed to the selection, recruitment and development of the best people, basing judgement solely on suitability for the job. The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to be made in order to perform the job or position sought. Any details provided will be kept confidential

Medical health history

• Asthma or hayfever
• Back, neck or joint problems
• Chest/respiratory problems
• Diabetes
• Epilepsy, fits, faints or blackouts
• Skin problems
• Heart disease or high blood pressure
• Mental health problems (eg anxiety / depression / stress)
• Kidney / bladder problems
• Hernia / rupture Stomach or bowel problems
• Circulation problems or blood disorders
• Varicose veins Allergies or immune disorders

 General Health and Lifestyle

• Do you have any current or past visual impairment (excluding glasses/lenses)
• Do you have poor hearing in either ear?
• Are you currently taking any medication or receiving any medical treatment?
• Are you currently pending a referral to see a specialist at a hospital clinic or due to be admitted to hospital?

Food Handling

• Do you suffer, or have you suffered from any of the following; Typhoid Fever or Paratyphoid Fever, Dysentry or Salmonella
• Have you ever had, or been in close contact with anyone known to have Tuberculosis?
• Have you suffered from Diarrhea, vomiting or any other stomach disorders within the last 4 weeks?
• Do you have any problems with your bowels, eg. Colitis, Irritable Bowel Syndrome, Crohns diseases or recurrent diarrhea?
• Any recurrent chest infections, with the production of phlegm?
• Any recurrent eye, ear, throat or mouth infections? 

Occupational Health

• Have you ever worked in a noisy environment where you had to shout to make yourself heard?
• Have you ever worked in a dusty environment where dust masks were required?
• Have you ever worked with power tools or other vibratory equipment?
• Do you have any difficulties wearing personal protective equipment? Eg. Gloves, safety glasses, footwear etc?

Do you have any personal or health problems that could affect; - Working in a hot or cold environment - Standing for long periods - Tasks that involve pushing, pulling, lifting or handling of loads - Climbing Stairs - Understanding information    

Night Health

The purpose of these questions are to make sure that you are suited to working at night.

• Diabetes
• Heart or circulatory disorders
• Stomach or intestinal disorders
• Any condition which causes difficulties sleeping
• Chronic chest disorders (especially if night time symptoms are troublesome)
• Any medical condition requiring medication to a strict timetable   
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2. 1. Do you suffer from any of the above * *

3.  If yes, give brief details  *

4. Agreements

By signing the below, I confirm:

1. The information provided in relation to health and disability section of this application is accurate.

2. I accept responsibility for notifying Lycon Recruitment of any changes to my medical condition to enable them to ensure my needs are met in terms of reasonable adjustments for access to their recruitment service and to my needs in order to perform the job or position sought or being undertaken.

3. I give my permission to Lycon Recruitment to share this information with occupational health professionals and / or clients to which I am supplied, where necessary to ensure my needs are met in terms of reasonable adjustments in order to perform the job or position sought or being undertaken.

4. Signature of Temporary Worker *

5. 5. Full name of Temporary Worker * *

6. 6. Today's date * *

1. Please read the terms of the 48 hour opt out agreement carefully then sign, print and date the relevant box to indicate your acceptance or refusal of the agreement.

1. Definitions

1.1. In this agreement the following definitions apply: -

“Assignment” means the period during which the Temporary Worker is supplied by the Employment Business to render services to the Client;

“Client” means the person, firm or corporate body together with any subsidiary or associated company as defined by the Companies Act 1985 to whom the Temporary Worker is supplied or introduced;

“Employment Business” means Lycon Recruitment LTD ,AMC House 12 Cumberland Avenue ,NW10 7QL  ;

“Temporary Worker” means the individual who is introduced by the Employment Business to render services to the Client;

“Working Week” means an average of 48 hours each week calculated over a 17 week reference period.

1.2. Unless the context otherwise requires, references to the singular include the plural.

1.3. The headings contained in these Terms are for convenience only and do not affect their interpretation.

2. Restriction

2.1. The Working Time Regulations 1998 (as amended) provide that the Temporary Worker shall not work on an Assignment with the Client in excess of the working week unless they agree in writing that this limit shall not apply.

3. Consent

3.1. The Temporary Worker hereby agrees that the Working Week limit shall not apply to the Assignment.

4. Withdrawal of Consent

4.1. The Temporary Worker may end this Agreement by giving the Employment Business 3 months notice in writing.

4.2. For the avoidance of doubt, any notice bringing this Agreement to an end shall not be construed as termination by the Temporary Worker of an Assignment with a Client.

4.3. Upon the expiry of the notice period set out in clause 4.1, the Working Week limit shall apply with immediate effect.

5. The Law

5.1. These Terms are governed by the law of England & Wales and are subject to the exclusive jurisdiction of the Courts of England & Wales.

2. 1. 48 hour opt out agreement Please select below confirmation of your decision to agree or refusal to the 48 Hour opt out agreement.

Acceptance – 48 hour opt out agreement

If you agree to the 48 hour opt out agreement , You understand the 48 hour working week limit will not apply and you are free to accept additional hours which may exceed 48 hours in a working week. As a reminder, under the terms of your contract for services agreement, you are free to accept or reject an assignment or additional hours offered.

Refusal – 48 hour opt out agreement

By selecting below you confirm your decision to refuse the 48 Hour opt out agreement. You understand the 48 hour working week limit will apply and you must not exceed this without first returning to our offices and completing the acceptance section of the 48 hour opt out agreement. 

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3. 2. Print Name * *

4. 3. Signature of Temporary Worker *

5. 4. Today's Date * *

1. 1. Temporary Workers Name * *

2. Road Transport (Working Time) Regulations

The Road Transport (Working Time) Regulations (RTWT) requires employment businesses to maintain records of the Working Time of the mobile workers who are involved in operations subject to EU drivers hours rules. An employment business is obliged to ensure that the working time limits specified below are complied with for a temporary workers they engage:

Summary of the RTWT Regulations

In summary the RTWT regulations provide for the following:

• Mobile drivers (such as HGV drivers and crew) are subject to a maximum Working Time of 48 hours per week over a default 17 week reference period; this default reference period may be changed to a rolling reference period and extended to 26 weeks in certain circumstances
• There is a maximum weekly limit of 60 Hours Working Time
• There is a maximum of 10 hours night work within each 24 hour period. Night time is defined as a midnight to 04:00am ( for goods vehicles and 01:00am and 05:00am (for passenger vehicles). This maximum may be extended in certain circumstances.
• Rest periods: Mobile workers must take the following breaks: 30 minutes after 6 hours Working Time and 45 minutes for over 9 hours Working Time. It is important to note that EU Drivers Hours breaks and rest periods still apply.

How we calculate your average Working Time

We will calculate your average Working Time over a 17 week calendar reference period. The reference period we will use begins on midnight on the nearest Monday morning on or after 1 April, 1 August and 1 December each year and ending at midnight at the beginning of the nearest Monday falling on or after 17 weeks of these dates. If we decide to operate a 26 week rolling reference period we will confirm this in writing to you,

Your responsibilities

It is your responsibility to inform us of all your Working Time during the reference periods we use and to keep us updated as to any additional Working time you undertake for other employers or employment businesses for these purposes during an assignment. It is also your responsibility to accurately record your Working Time during an assignment.

RTWT Regulations have been introduced to protect and safeguard the health and safety of mobile worker, other road users and the public.

A mobile worker also has a responsibility for complying with the regulations. If the mobile worker knowingly breaks the rules (eg neglects to inform their employer or employment business about other work, or knowingly makes a false record), then they will be committing a criminal offence and may be subject to a fine on conviction of up to £5000. (Regulation 18 of the RTWT Regulations).

The RTWT Regulations require that all work undertaken for other employers must be taken into account when we calculate your Working Time during the televant reference period. Both transport and non-transport work must be taken into account.

Accordingly, please provide details of Working Time undertaken for any other employers or employment businesses during the current 17 week reference period. See above for the dates of the relevant 17 week reference period.See above for the dates of the relevant 17 week reference period.

Both transport and non-transport working time must be declared. If you are engaged charitable or voluntary work, or work for the TA, fire service or police you must inform us and you should fill out the chart below as if you were engaged in other work, even though we may exclude time spent on such activities from our calculation of your Working Time

3. 2. Mobile workers declaration

Please complete one of the following two declarations:

I declare that: I have accurately detailed all my Working Time during the current reference period in the provided chart and that it is true and correct to the best of my knowledge; As stated I AM NOT / I AM ( please select below which applies to you) currently engaged in any work, other than for Lycon Recruitment LTD which needs to be included in the calculations of my Working Time under the RTWT Regulations; and I will keep Lycon Recruitment informed in writing as to the details of Working Time undertaken for other employers or employment businesses on a weekly basis; and I will inform Lycon Recruitment immediately of there are any changed to my situation which impacts on my working time * 

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4.

5.

1. 1. STATUTORY/CONTRACTUAL REQUIREMENT: 

Your personal data is required by law (e.g. under Prevention of Illegal Working Act 2006, Health and Safety Executive, HMRC, Recruitment and Employment Confederation) and/or contractual requirement (e.g. our client may require this personal data), and/or a requirement necessary to enter into a contract. You are obliged to provide the personal data and if you do not, the work finding services will not be provided to you.

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2. 2. HEIGHT RESTRICTIONS:

It is your responsibility to ensure you are aware of the maximum height of your vehicle and any height restrictions on your chosen route and any loading areas. You MUST NOT under any circumstances attempt to pass under a restricted area unless you are sure. If the height of your vehicle is not displayed in your cab YOU MUST report to the traffic office to get this information before leaving the yard.

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3. 3. FINE DEDUCTIONS:

When driving for any of our clients you will be responsible for any payment of fines imposed by an approved authority E.G Police/Traffic Wardens in the time you are responsible for the vehicle. Driving Force is legally obligated to notify the authority of your name and address and in most circumstances will pay the fine providing you sign and agree to have this amount deducted from your pay.

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4. 4. DVLA LICENCE CHECK:

I understand the company will ask the DVLA for my driver record information, as and when they require, for the purpose of work finding services. It will do so in accordance with the General Data Protection Regulation and the legal bases for processing data in accordance with the Company’s privacy notice.

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5. 5. MARKETING:

I consent for my contact data to be used by  Lycon Recruitment Limited for the purposes of marketing services, additional to those of recruitment and training, which may be offered by Lycon Recruitment, their subsidiaries and/or third-party suppliers. This consent will remain valid for the same periods detailed within our privacy notice according to your status, save where you exercise your rights to withdraw this consent. Where you have consented to marketing you have the right to withdraw that consent at any time by unsubscribing on marketing email or by emailing Data Protection Officer admin@lycon-recruitment.co.uk

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6. 6. REFERENCES:

I give my full consent for the above-named company to provide details of my employment to Driving Force Recruitment Ltd, including: dates of employment, accident record, customer service record, absenteeism record. I understand that my data will be processed accordingly in line with Driving Force’s privacy notice.

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7. Training : 

Lycon Recruitment might sometimes pay for certain training for you ,in order to recuperate the fund deduction will be made from your payment if you quit the job within 3 months  of the training

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8. Policies

7. Personal Information/Right to Work

I confirm that all personal information completed and inputted by myself is True and Factual. I confirm that any documents used to confirm my identity and any relevant qualifications are originals and have not been tampered with in anyway and represent a True Likeness to myself. *

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9. GENERAL DATA PROTECTION REGULATION

The information that you provide on this application and on any CV given will be used by Lycon Recruitment LTD to provide you employment finding services. In providing this service to you, you understand your data will be processed accordingly in line with Lycon Recruitment’s privacy notice. Lycon Recruitment LTD may check the information collected, with third parties or with other information held by Lycon Recruitment LTD. Lycon Recruitment may also use or pass on certain information to third parties to prevent or detect crime, to protect public funds or in other ways permitted or required by law.

9. Safe Driver Scheme

As a professional driver, you understand that it is your responsibility to drive in a safe and legal manner at all times and complete all relevant vehicle checks. Damage caused by driver negligence could result in you being personally responsible for charges of up to £500, which will be deducted from your pay at the earliest opportunity. By signing this form, you agree to this amount being deducted from your weekly pay. Please note that no deductions will be made if you have not worked that week.

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10. 10. I confirm that I agree with the declarations and Policies listed within this registration pack, and that the information given in this document is correct. I confirm that I have uploaded my own information and I understand that a misleading/false statement or unsatisfactory reference could be the cause for rejection or, if employed, dismissal.  *

11. 11. Today's Date * *

1. For the purpose of this policy the following definitions shall apply:

Worker: The agency workers regardless of the contract they may be engaged in.

Hirer: The party, being either the client of end user, to whom you are supplied temporarily under an assignment and under whose supervision, direction and control you work.

Equal Opportunities

Lycon Recruitment are committed to treating everyone equally and will not discriminate on the grounds of an individual’s “protected characteristic” under the Equality Act 2010 (the Act). We will not discriminate on the grounds of an individual’s membership or non-membership of a Trade Union and all workers have an obligation to respect and comply with this policy. As a business Lycon Recruitment embraces diversity and aims to promote the benefits of diversity in all of our business activities. Whilst representing Lycon Recruitment on temporary assignment, you must conduct yourself in an appropriate manner and ensure that you do not discriminate against another person or engage in any conduct which may result in discrimination, harassment, bullying or the victimization of another individual which will not be tolerated. For the avoidance of doubt, the following passages highlight areas of the Equality act 2010 which you are expected to abide by.

Protected Characteristic

The Equality Act 2010 makes it unlawful to discriminate against people with a ‘protected characteristic, those protected characteristics are listed and defied below:

• age

• being or becoming a transsexual person

• being married or in a civil partnership

• being pregnant or on maternity leave

• disability

• race including colour, nationality, ethnic or national origin

• religion, belief or lack of religion/belief

• sex / sexual orientation

Age

The Act protects people of all ages. Age is the only protected characteristic that allows the Hirers or Lycon Recruitment to justify direct discrimination.

Disability

Under the Act, a person is disabled if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities, which would include things like using a telephone, reading a book or using public transport.

The Act includes protection from discrimination arising from disability. This states that it is discrimination to treat a disabled person unfavourably because of something connected with their disability.

Gender reassignment

The Act provides protection for transsexual people. A transsexual person is someone who proposes to, starts or has completed a process to change his or her gender. The Act no longer requires a person to be under medical supervision to be protected – so a woman who decides to live as a man but does not undergo any medical procedures would be covered.

Marriage and civil partnership

The Act protects workers who are married or in a civil partnership against discrimination. Single people are not protected.

Pregnancy and maternity

A woman is protected against discrimination on the grounds of pregnancy and maternity during the period of her pregnancy and any statutory maternity leave to which she is entitled. During this period, pregnancy and maternity discrimination cannot be treated as sex discrimination.

Race

For the purposes of the Act ‘race’ includes colour, nationality and ethnic or national origins.

Religion and belief

In the Equality Act, religion includes any religion. It also includes a lack of religion, in other words Workers are protected if they do not follow a certain religion or have no religion at all. Additionally, a religion must have a clear structure and belief system. Belief means any religious or philosophical belief or a lack of such belief. To be protected, a belief must satisfy various criteria, including that it is a weighty and substantial aspect of human life and behaviour. Denominations or sects within a religion can be considered a protected religion or religious belief. Discrimination because of religion or belief can occur even where both the discriminator and recipient are of the same religion or belief.

Sex

Both men and women are protected under the Act. Sexual orientation The Act protects bisexual, gay, heterosexual and lesbian people. Discrimination can come in more than one form, when you are speaking to individuals you need to be aware of what topics you choose to share within your working environment in order not to offend others and pose a risk of discrimination. All protected characteristics are relevant in association to discrimination: Direct discrimination Direct discrimination occurs when someone is treated less favourably than another person because of a protected characteristic they have or are thought to have or because they associate with someone who has a protected characteristic

Discrimination by association

This is direct discrimination against someone because they associate with another person who possesses a protected characteristic.

Perception discrimination

This is direct discrimination against an individual because others think they possess a particular protected characteristic. It applies even if the person does not actually possess that characteristic.

Indirect discrimination

Indirect discrimination can occur when you have a condition, rule, policy or even a practice within Lycon Recruitment that applies to everyone but particularly disadvantages people who share a protected characteristic. Indirect discrimination can be justified if you can show that you acted reasonably in managing the situation, ie that it is ‘a proportionate means of achieving a legitimate aim’.

A legitimate aim might be any lawful decision you make in running your business or organisation, but if there is a discriminatory effect, the sole aim of reducing costs is likely to be unlawful. Being proportionate really means being fair and reasonable, including showing that you’ve looked at ‘less discriminatory’ alternatives to any decision you make.

Dignity at work

As part of its overall commitment to equal opportunities, Lycon Recruitment are fully committed to promoting a harmonious working environment. All workers have the right to be treated with respect and dignity, in an environment free from harassment, victimisation and bullying, whether it is related to disability, race, gender, health, social class, sexual preference, marital status, nationality, religion, employment status, age or membership or Non-membership of a trade union.

Harassment

Harassment is “unwanted conduct related to a relevant protected characteristic, which has the purpose or effect of violating an individual’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual”.

Harassment applies to all protected characteristics except for pregnancy and maternity and marriage and civil partnership. Workers will now be able to complain of behaviour that they find offensive even if it is not directed at them, and the complainant need not possess the relevant characteristic themselves. Workers are also protected from harassment because of perception and association (see page 3).

Bullying

Bullying means any unwanted behaviour that makes someone feel intimidated, degraded, humiliated or offended. It is not necessarily always obvious or apparent to others, and may happen in the workplace without a hirer’s or gap personnel’s awareness.

Bullying can be between two individuals or it may involve groups of people. It might be obvious or it might be insidious. It may be persistent or an isolated incident. It can also occur in written communications, by phone or through email, not just face-to-face.

Examples of bullying behaviour could include:

• spreading malicious rumours, or insulting someone
• exclusion or victimisation
• unfair treatment
• deliberately undermining a competent worker by constant criticism.

Victimisation

Victimisation occurs when a worker is treated badly because they have made or supported a complaint or raised a grievance under the Equality Act; or because they are suspected of doing so. A worker is not protected from victimisation if they have maliciously made or supported an untrue complaint. A complainant will not need to compare their treatment with that of a person who has not made or supported a claim under the Act. 

2. 1. With this in mind, regardless of your individual beliefs or opinions whilst you are in work representing Lycon Recruitment your conduct should reflect this and you should treat all individuals how you expect to be treated.  *

3. 2. Full name of worker * *

1. NOTE TO ALL CANDIDATES:

Welcome to Lycon Recruitment. Our aim is to make your working experience as easy as possible. Whilst you are working for our clients you are representing Lycon Recruitment please follow the guidelines below :

 * Arrive on time for the start of your shift

 * Always take licences, hi viz and safety footwear with you.

 * Be polite and courteous at all times.

 * Keep in contact with the depot, please alert them of any delays/ changes etc throughout the day.

 * Please ensure you adhere to all Drivers Hours laws and regulations

 * Please ensure you complete Vehicle checks prior to driving the vehicle, any defects must be reported to the transport office.

 * Please report any accidents / incidents as soon as they occur to both Driving Force and the client you’re working for.

 * Our working week is Sunday to Saturday, unless stated otherwise.

* All timesheets/hours worked must be received by Monday 10am at the latest, failure to do so will result in delayed payment.

This is YOUR RESPONSIBILITY and not for Driving Force to chase.

* You will receive your wages on a Friday, one week in arrears.

* It is your responsibility to inform Driving Force of any changes to your licences, address, bank details or circumstances. 

2. 1. I understand and agree to all of the above: *  *

3. 2. Today's Date * *

1. 1. Between Lycon Recruitment Limited and ( please enter your full name below ) * *

2. Recitals

(1) Lycon Recruitment Limited also operate as a Transport and Logistics Recruitment business .

(2) The Road Transport working Time Regulations came into force on 2nd January 2006 and affect the manner in which mobile workers and the company together conduct the operation.

(3) Lycon Recruitment Limited and the representatives of the workforce have agreed on behalf of the workforce to adopt the flexibility provided by the regulations in respect of the night-work limit.

Provisions

1. Definitions

“The Regulations” means the European communities (organisation of working Time of persons performing mobile Road Transport Regulations 2012 (Si 36 of 2012) hereafter called the Road Transport working Time Regulations 2012

“Client” means the person, firm or corporate body together with any subsidiary or associated company as defined by the Companies Act 1985 to whom the Temporary Worker is supplied or introduced;

“Employment Business” means Lycon Recruitment Limited of AMC House ,12 Cumberland Avenue ,NW10 7QL ;

“Temporary Worker” means the individual who is introduced by the Employment Business to render services to the Client;

“The Parties” means the Employment Business and the Temporary Worker;

2. Scope of agreement

This agreement is concerned with extending the night working limit as provided for in the directive.

3. Term of the agreement

This agreement shall remain in force for a period of 5 years from the date signed below

4. Consent

4.1. The Employment business and the Temporary Worker hereby agrees that the night-work limit shall not apply to the Assignment

5. Withdrawal of Consent

5.1. The Temporary Worker may end this Agreement by giving the Employment Business 3 months’ notice in writing

5.2. For the avoidance of doubt, any notice bringing this Agreement to an end shall not be construed as termination by The Temporary Worker of an Assignment with a Client.

5.3 Upon the expiry of the notice period set out in clause 5.1, the night-work limit shall apply with immediate effect.

6. Operative provision

6.1 The parties acknowledge and agree that the regulations will impact upon the manner in which the operation is conducted. The parties believe that it is in the benefit of both the company and the employees for certain of the provisions of the regulations to be extended or modified

6.2 Night work limit The Temporary worker will work beyond the 10-hour night work limit stated in the regulations but only to the extent where this would not be in breach of other provisions of the regulation or EU drivers’ Hours Regulations

7. Avoidance of doubt For the avoidance of doubt, the parties acknowledge and agree that, save as specifically set out above, the provisions of the regulations shall be in full force and effect. 

3. 2. Acceptance – Night-work limit extension agreement

By signing below you confirm your decision to agree to the night-work limit extension agreement. You understand the night-work limit will not apply and you are free to work additional hours which may exceed 10 hours in a single night shift. As a reminder, under the terms of your contract for services agreement, you are free to accept or reject an assignment or additional hours offered. 

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4. 4. Today's Date *

GENERAL INFORMATION

Name of employment business: Lycon Recruitment LTD

Name of intermediary or umbrella company: NumberMill Limited

Candidateʼs employer: NumberMill Limited

Type of contract candidate will be engaged under: Contract of Employment

Who will be responsible for paying the candidate: NumberMill Limited

How often the candidate will be paid: Weekly following receipt of hours worked

INTERMEDIARY OR UMBRELLA COMPANY PAY INFORMATION

Candidates are being paid through an intermediary or umbrella company: a third-party organisation that will calculate candidateʼs tax and other deductions and then pay candidate for the work undertaken for the hirer. Lycon Recruitment will still be finding candidateʼs assignments. The money earned on candidateʼs assignments will be transferred to the umbrella company as part of their income. They will then pay candidate their wage. All the deductions made which affect candidateʼs wage are listed below. Candidate payslip may show candidate as an employee of the umbrella company listed below. Name of intermediary or umbrella company: NumberMill Limited Any business connection between the intermediary or umbrella company, the employment business and the person responsible for paying the candidate: N/A

Expected or minimum gross rate of pay transferred to the intermediary or umbrella company from Lycon Recruitment LTD: £16.01 per hour, Deductions from intermediary or umbrella income required by law: Employerʼs National Insurance, Apprenticeship Levy, Employerʼs Pension Contributions (where applicable), Holiday Pay (if the employee opts to accrue and be paid at a later date) Any other deductions from umbrella income (to include amounts or how they are calculated) Company Margin (£10.00/Week)  Expected or minimum rate of pay to candidate: National Minimum/Living Wage (currently £12.21/hour) Deductions from your wage required by law: Income Tax (PAYE) National Insurance Contributions Pension Contributions (where applicable) Any other deductions or costs taken from your wage (to include amounts or how they are calculated): N/A

Any fees for goods or services: N/A

Holiday entitlement and pay: 33.00 days (14.54%) Additional benefits: Statutory Employment Rights. Access to Employee Health, Wellbeing and Benefits platform

EXAMPLE PAY 1

Intermediary or umbrella fees Worker fees Example gross rate of pay to intermediary or umbrella company from Lycon Recruitment: (40.00 X £22.00) = £880.00 Deductions from intermediary or umbrella income required by law: Apprenticeship Levy - £3.83 Employer's NI - £100.46 Any other deductions or costs taken from intermediary or umbrella income: Company Margin - £10.00 Example rate of pay to you: £16.71/hour (£668.51) + Holiday Pay (£97.20) Deductions from your pay required by law: Income Tax - £104.60 National Insurance - £41.90 Any other deductions or costs taken from your pay: £0.00 Any fees for goods or services: £0.00 Example net take home pay: £619.21

EXAMPLE 2

 Example gross rate of pay to intermediary or umbrella company from Lycon Recruitment: (40.00 X £16.15) = £646.00 Deductions from intermediary or umbrella income required by law: Apprenticeship Levy - £2.82 Employer's NI - £70.07 Any other deductions or costs taken from intermediary or umbrella income: Company Margin - £10.00 Example rate of pay to you: £12.29/hour (£491.63) + Holiday Pay (£71.48) Deductions from your pay required by law: Income Tax - £64.20 National Insurance - £25.69 Any other deductions or costs taken from your pay: £0.00 Any fees for goods or services: £0.00 Example net take home pay: £473.22 

1. Date *

2. Signature *