Contractor declaration forM

Spencer Ogden
SECTION 1: EMPLOYEE DETAILS (Mandatory to Complete)
First & Middle Name: Surname:

Residency: Others:

Visa Status (if applicable): Visa Expiry Date (if applicable):

Date of Birth: Nationality: Others: Sex:

Address Line 1: City:

Address Line 2: Postal/Zip Code:

Address Line 3: County or State/Province:

Country:

Contact Number: Email Address:

SECTION 2: EMERGENCY CONTACT DETAILS (Mandatory to Complete)

Full Name: Relationship:

Home Address in full:

Post Code:

Contact Number: Email Address:

SECTION 3: References
Reference 1 Reference 2

Full Name: Full Name:

Company: Company:

Title: Title:

Contact Number: Contact Number:

Email Address: Email Address:

SECTION 5: personal information (Mandatory to Complete)

Are you an undischarged bankrupt?: Have you been convicted in a court of law in Singapore or in Have you consulted a specialist in the last 12
any other country (excluding traffic offences) months?:

Details of any medical conditions:

(e.g. asthma, allergies, injuries)

Fit to work declaration: I confirm I deem myself fit to perform the role offered and that I have made the necessary enquiries about the physical requirements of the job
and am fit to complete this role. i confirm i have disclosed all medical conditions to the Client and Spencer Ogden and have made them aware of any potential effects on my
ability to perform my role as a result of this. Should my circumstances change, I will inform Spencer Ogden of any changes that may impact my ability to perform my role. i
further confirm that should i have a medical incident on site, I will inform my Spencer Ogden Recruitment Consultant and the Compliance and Contractor Services team on
emergencies@spencer-ogden.com within 24 hours of the incident occurring or as soon as possible thereafter. Phone numbers for support in the below time zones are: GMT: +44
161 227 4914/+44 207 2689 340 / CST: +1 713 358 7913 / SGT: +65 3163 5011.

SECTION 6: DECLARATION
Spencer Ogden and its clients will use information from your Personal Details Form for the purpose of employment and facilitation of paying and administering your employee
benefits. The information you give us will not be disclosed to third parties without your consent except where necessary to confirm factual information and in compiling
anonymous statistical data submitted to Government agencies. Access to sensitive personal data is controlled and confined to staff with responsibilities in these areas.
Candidate Declaration: I confirm that to the best of my knowledge the information I have provided on this registration form is correct and true. I realize that
if it is found that I have deliberately given false or misleading information my assignment may be terminated without notice.

Signature: Date: