Name * First Name Last Name Email * Phone * (###) ### #### Date Of Birth * MM DD YYYY Address * Job Role * NI Number * Driving License Number Next of kin - Name & Phone phone number * Immigration share code if needed Have you had any unspent criminal convictions in the last 5 years? * Yes No Do you have any health issues or a disability that may impact your role? * Yes No How would yoou prefer to be paid? PAYE Umbrella LTD company Thank you! rEGISTRATION FORM Please fill in all required fields on the form below to register with AGN Recruitment LTD.