Personal Details

This form will take around 15 minutes to complete, if at any point you need to save and exit, please use the 'Save' button at the bottom of the form.
You can then return to complete and submit via your Onboarding Portal. Thank you for taking the time to complete your New Starter Information!

Section 1: Personal Details

Title
Mr

Firstname
Alexandru

Surname
Stroe

Middle names
Daniel

Known As
Alex

Home Address
Flat 73
Lee Heights Court
Maidstone
Kent
ME14 2LD

Postcode
ME14 2LD

Daytime Telephone Number

Mobile Telephone Number

07463982460

Email address
alexandrudstroe@gmail.com

Date of Birth
13-Jun-2003

Do you have a national insurance number?

Yes

National Insurance Number

TK180960A

Nationality
Romanian

Marital Status
Single

Referral

Have you been referred by one of Evri Employees?

No

Have you worked for Evri before, either directly or via agency/contractor?
No

Driving

Do you hold a current, full UK driving licence?

No

Will you be receiving a car allowance as part of your new role?

No
Will you be opting for a company car as part of your new role? If yes our provider Global will be in touch to discuss next steps.
No

Convictions

Have you ever been convicted of any criminal offence? (spent convictions need not be disclosed)
No

Do you have any pending prosecutions?

No

Bank Details

To avoid any delays in payment, please provide details of your bank/building society including the name of the account holder and address of the
bank. The details you supply will be processed in a confidential and secure manner.

Is this a bank / building society account?

Bank

Bank Name (Name of your Bank)

Starling Bank

Sort code (e.g. 11-11-11)

60-83-71

Account number
83909391

Account Holder’s Name (Your full name with the bank)

Alexandru Stroe

Emergency Contact

Section 2: Emergency Contact

Please provide details of who we should contact in case of an emergency, if you would like to add further contacts you will be able to do this in our
HR System once you have started

Name
Alina Zoana

Address Line 1
2, St. Clements Road

Address Line 2
Warden, Kent

Address Line 3

Address Line 4

Postcode
ME12 4NE

Best contact number

07311227927

Relationship
Sister In Law

HMRC New Starter Checklist

Section 3: HMRC New Starter Checklist

If this information is not completed, we are unable to process you with payroll

Employee statement
Choose the statement that applies to you, either A, B or C.
B - Since 6 April I have had another job but I do not have a P45. And/or since the 6 April I have received payments from any of the following:
Jobseeker’s Allowance, Employment and Support Allowance or Incapacity Benefit

Student loans

Do you have a Student Loan that is not fully repaid?

No

Postgraduate Loan

You have a Postgraduate Loan if any of the following apply:

• you lived in England and started your Postgraduate Master’s course on or after 1 August 2016
• you lived in Wales and started your Postgraduate Master’s course on or after 1 August 2017
• you lived in England or Wales and started your Postgraduate Doctoral course on or after 1 August 2018

Do you have a Postgraduate Loan that is not fully repaid?

No

Are you male or female? (for payroll purposes)

Male

I confirm that the information I’ve given on this form is correct

Yes

Diversity Data

Section 4: Diversity Data

What is your gender?

Male/Man

Choosing from these options, how would you best describe your gender identity?
Cisgender

What are your pronouns?

He/Him

Choosing from these options, how would you best describe your sexuality?
Gay/Lesbian

Do you have a disability or long-term health condition as defined by the Equality Act 2010?
No

Do you recognise yourself to be Neurodivergent (e.g. Autism, ADHD, Dyslexia, Dyspraxia)?

No

Choosing from these options, how would you best describe your ethnicity?
Any other White background

Choosing from these options, how would you best describe your religion?
Non-religious

Do you recognise yourself to have any caring responsibilities, outside of work?

No

What was the occupation of your main household earner when you were around aged 14?
Unsure

Which type of school did you attend for most of the time, between the ages of 11 and 18?
Attended school outside of the UK

Health Questionnaire

Section 5: Health Questionnaire

Please answer the following questions. If your answer is YES, please provide the details including when, length of illness and current state of
health.

Completion of this questionnaire is optional, and any information you provide will be used to identify any appropriate support required.
Have you ever (including childhood) suffered from or do you currently suffer from:

Epilepsy, fainting attacks, blackouts

No

Heart disease, angina, raised blood pressure

No

Asthma, bronchitis, pneumonia or any other chest illness

No

Diabetes, thyroid or gland trouble

No

Migraine or frequent headaches

No

Dermatitis, eczema or other skin complaints

No

Cystitis, bladder or kidney trouble

No

Gastric or stomach disorders

No

Breathlessness, palpitations, swelling of the ankles

No

Rheumatism, rheumatic fever, arthritis, other joint problems

No

Hernia, rupture or varicose veins

No

Jaundice or hepatitis
No

Hay fever, recurrent tonsillitis or sinusitis

No

Tuberculosis (or close family contact with sufferer)

No

Typhoid, prolonged or severe diarrhoea or food poisoning

No

Have you ever failed a medical examination?

No

Are you sensitive or allergic to any drugs or substances?

No

Have you ever been an in-patient in hospital (other than in connection with a normal pregnancy)?
No

Have you any defect of sight?

No

Do you wear glasses or contact lenses?

Yes

Please provide details

I wear glasses

Do you have any hearing defects?

No

Do you wear a hearing aid?

No

Have you ever been treated for your nerves, depression or any mental illness?
No

Do you or have you ever had a drug or alcohol dependency?

No

Have you ever suffered prolonged or severe pain or injury to your neck or back?
No
Have you ever suffered prolonged or severe pain to your fingers, wrist or arms?
No

Have you ever had any injury or disability to your feet or knees?
No

Have you ever suffered an industrial injury?

No

Have you ever received compensation/disability payments?

No

Is there any reason why you cannot carry out strenuous physical work including climbing ladders, working from heights, bending, lifting, carrying, pushing or
pulling operations?
No

Are you at present taking any tablets or injections prescribed by a doctor? (Other than birth control)
No

Are you disabled in any way?

No

Are there any reasonable adjustments e.g. wheelchair access, that we can make to help you in the job for which you have applied?
No

Are you at present in good health?

Yes

Please use this space to supply any further details you feel are necessary with regards to this health questionnaire

I agree
Yes

Agree date
21-Nov-2023

Working Time Regulation

Section 6: Working Time Regulation

Under Regulation 4(1) of the Working Time Regulations 1998, you can only work more than 48 hours a week on average (including overtime and
time worked for other employers or businesses) if you have agreed to do so in writing.

Please tick below to confirm that you agree that the limit on weekly working time does/does not apply to you.

If you have agreed to work in excess of 48 hours per week and but change your mind in the future, you can end this letter of agreement at any time
by giving at least three months’ notice written notice to the HR Department, otherwise it will continue. The contact details for providing written
notice are as below;

HR Support Team
Evri
Capitol Court
Capitol House
Morley
Leeds
LS27 0WH
Email: my.HR@evri.com

After the three months’ notice, any terms of employment affected by this letter of agreement will revert to those in force immediately prior to this
letter of agreement.

I can confirm that I have been notified of my right under the Working Time Regulations (WTR) and that, having considered these rights, I have
decided that I would like to opt out of the WTR.

I understand that by ticking the box below I am consenting to work in excess of 48 hours on average per week, over a rolling 17 week period.

This agreement does not affect my entitlement under the WTR to minimum daily or weekly rest periods.

I can confirm that this consent will continue throughout my employment unless and until I provide the Company with one month’s written notice of
the withdrawal of my consent under this agreement.
I confirm I have read the information about WTR
Yes

I agree that I am opting out

Yes

Date of opting out

21-Nov-2023

Beneficiaries

Section 7: Beneficiaries

In the event of your death the Trustees will decide who will receive any benefit payable under the terms of the Scheme. They will take into account
your circumstances at the time of your death and your wishes as shown in this form.

This form is not legally binding on the Trustees and will be used only as a guide by the Trustees when exercising their discretion under the terms of
the Trust.

Beneficiary 1

Name
Marian-Madalin Stroe

Address
2, St. Clements Road, Warden, Kent, ME12 4NE

Relationship
Brother

Date of birth
26-Aug-1995

Desired percentage of benefit payable

25

Beneficiary 2

Name
Nicoleta Alina Zoana

Address
2, St. Clements Road, Warden, Kent, ME12 4NE

Relationship
Sister in la

Date of birth
17-Dec-1997

Desired percentage of benefit payable

25

Beneficiary 3

Name
Marius-Gabriel Stroe

Address
103, Northgate Street, Great Yarmouth, Norfolk, NR30 1BP

Relationship
Father

Date of birth
15-Jul-1971

Desired percentage of benefit payable

25

Beneficiary 4

Name
Coca-Georgeta Dragan
Address
57 Nicolae Balcescu, Dor Marunt village, Dor Marunt commune, Calarasi county, Romania

Relationship
Mother

Date of birth
17-Dec-1975

Desired percentage of benefit payable

25

Please complete this section should you have any additional beneficiaries in excess of the 4 above

You can complete a fresh expression of wish form at any time and you will need to give this to your employer

Name
Alexandru Stroe

Date
21-Nov-2023

I understand that, in exercising any discretion, the Trustees will not be bound in any way by my wishes, but I would like the Trustees to bear them in mind.
This expression of wish replaces any previously made by me.
I confirm

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