Employee Reliability Survey

Vet a person's suitability to handle merchandise, equipment, and money: background history, references, banking details, medical conditions, and signed declarations. A thorough screening for roles that demand complete trust.

Use this template

Information

Full Name

Present Address

Postcode

Date of Birth

Home Phone

Mobile Phone

National Insurance Number

EMAIL *mandatory field

Have you ever:- been arrested, been convicted of a misdemeanour, been convicted of a felony, filed for bankruptcy or been on parole?

Arrested Convicted of a misdemeanour Convicted of a felony Filed for bankruptcy Been on parole None of the above

If YES to any, please explain:

Information

Name of Bank

Name on Account

Account Number

Sort Code

Information

Name of Referee

Business Name

Location

Email Address

Contact Number

Information

Signed:

Sign here

Date:

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Do you have any medical conditions we should be aware of?

Yes No Prefer not to say

If Yes,

Do you take any medication we should be aware of?

Yes No Prefer not to say

If Yes,

Information

Full Name, Mobile Number, Alternate Number and Relation to You

Information

BA Name:

Signature:

Sign here

Date:

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Information

Name:

Signed:

Sign here

Date:

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Information

BA Name:

Signature:

Sign here

Date:

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Have you ever been convicted of committing a violent, sexual or theft offence?

Yes No Prefer not to say

Have you ever had a custodial sentence of over 2.5 years?

Yes No Prefer not to say

Are you on the sex offenders register?

Yes No Prefer not to say

Have you ever been convicted of an offence relating to drugs?

Yes No Prefer not to say

Have you ever been convicted of an offence relating to fraud or financial exploitation?

Yes No Prefer not to say

Have you ever been convicted of any criminal offence that you wish to bring to our attention?

Yes No Prefer not to say

If YES, please give details of sentence (including length of sentence and date of conviction):

Brand Ambassador Statement - I have provided a full and thorough answer to the questions above. I am aware that failure to disclose details of an unspent criminal conviction or offence may result in disciplinary action and an assessment of my suitability to perform the role.

DATE:

Signature:

Sign here

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Information

Name:

Signature:

Sign here

Date:

Information

Name:

Signature:

Sign here

Date:

Information

9.1. Always write in the first person, identify who you are and what your role is, and use the following disclaimer "The views expressed are my own and don't reflect the

Information

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"I have read, understood and agree to comply with the BA Field Risk Assessment"

Nombre

Apellido

Signature

Sign here

"I have read, understood and agree to comply with the "Face to Face Interacting with the Public Safely - Guidelines"

Nombre

Apellido

Signature

Sign here

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