Application Form

Application Form
Full Name *

First Name Last Name
Address: Number / Road *
Town *
Post Code *
Date of Birth *
National Insurance Number *
E-mail *
Telephone *
Your employment status:
If you have a recent P45 from your last employment please attach a scan or readable photograph of it here
I am an EU National

Tick
I am not an EU National

Tick
Please choose one of the following three options detailed below: *
Option A This is my first job since last 6 April and I HAVE NOT been receiving taxable Jobseeker's Allowance, Employment and Support Allowance or taxable Incapacity Benefit or a state or occupational pension.

Option B This is now my only job, but since last 6 April I HAVE had another PAYE job, or have received taxable Jobseeker's allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a state or occupational pension

Option C I have another job or receive a state or occupational pension
If you left your course of UK Higher Education before last 6 April and received your first UK student loan instalment on or after 1998 and you have not fully repaid your student loan, tick option D.(Do not tick option D if you are repaying your student loan by agreement with the student Loans Company to make monthly payments through your bank or building society account.)
Option D
Where would you like to be paid:
Bank Name
Sort Code *
Account Number *
Account Name *
I UNDERSTAND I WILL RECEIVE MY PAYMENTS THROUGH DUPLEX PAYROLL. IN ACCORDANCE WITH THE DATA PROTECTION ACT 1988 DUPLEX IS REGISTERED TO HOLD MY INFORMATION BOTH ELECTRONICALLY AND ON PAPER FILES FOR THE PERIOD DEEMED NECESSARY INCLUDING BUT NOT LIMITED TO PROCESSING MY PAY. I ACKNOWLEDGE THAT MY DETAILS WILL NOT BE RELEASED TO THIRD PARTIES UNLESS IT IS REQUIRED BY HMRC OR ANOTHER ENFORCEMENT AGENCY.
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Application Form

Your employment status:

Where would you like to be paid: