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Example form of a written statement of employment particulars URN No: 06/534
This is an example of a possible form of a written statement of employment particulars meeting the requirements of Employment
legislation.
For a detailed explanation of these requirements see: Written statement of employment particulars - Guidance.The written statement
may be provided either:
a) as a single document;
or
b) in a number of instalments - provided that certain details, dealt with in paras 1-8 , are always given together in the same instalment.
All instalments must be given to the employee not later than two months after he/she starts work or if, at an earlier stage
he/she is required to work outside the UK for more than one month, not later than his/ her departure.
Unless otherwise indicated, all particulars must be set out in the statement itself and not be given by reference to: a collective agreement; a handbook; or any other document which does not form part of the written
statement.
Lengthy or complicated particulars may be given on a continuation sheet or via an attached booklet or other annex - provided it is clear that this is integral to the statement, or the relevant instalment of it, and forms part of the same
document.
Where there are no particulars to be given for paras 1-14 , the statement must say so in each case.
Some of the separate stages in paras 15-21 may be combined where, for example:
a) the same person is the first to be approached for appeals against disciplinary (or, from 1 October 2004, dismissal) decisions
and for grievances;
or
b) the method of application in both cases is the same.
Until 1 October 2004 (when this exemption will be removed) an employer with fewer than 20 employees (including the employee
who will be issued with the statement) need not include the information specified in paras 15, 17, 18 and 21.
Paragraph 16 applies (regardless of size of employer) only from 1 October 2004.
Explanatory notes for completion are given in the right hand column on each page.
Note: Some terms and conditions of employment are subject to statutory requirements, eg rates of pay, working hours and holidays,
notice of termination of employment and, from 1 October 20041, disciplinary and grievance procedures. For information please see: A detailed guide to the national minimum wage, Your guide
to the Working Time Regulations, Rights to notice and reason for dismissal and the Resolving disputes web page.
1 The statutory procedures will apply when an employer first contemplates dismissal or disciplinary action on or after 1 October
2004, but not when a procedure of the employer's own has been started before that date.
Written Statement of employment particulars
Notes for completion of form
Insert:
P1
You
P1:
1 Name of employee
began employment with
2 Name of employer
on
3 Date employment started
P2
*a. Your previous employment with
P2:*delete (a) or (b) as appropriate
4 Name of previous employer or employers
does count as part of your period of continuous employment which therefore began on
5 Date period of continuous employment commenced
or
*b. Your previous employment does not count as part of your period of continuous employment
P3
a. You are employed as
P3:(complete (a) or (b), delete the other)
6 Job title
or
or
b. A brief description of the work for which you are employed is:
7 Brief work description
P4
a. Your place of work is
P4:(complete (a) or (b), delete the other)
8 Address of workplace
b. You are *required/permitted to work at the following places
or *delete as appropriate
9 Give details
and the address of your employer is
10 Address of employer
P5
Your pay will be
P5:
11 Particulars of scale or rate of renumeration, or of the method of calculating remuneration
P6
You will be paid
P6:
12 Particulars of intervals at which remuneration is to be paid
P7
Your hours of work are
P7:
13 Particulars (see note above) - including details of any normal working hours
P8
Your holiday entitlement is
P8:
14 Particulars (see note above) - including entitlement to holiday pay and public holidays. You must give enough information to enable entitlement, including accrued holiday pay on termination, to be precisely calculated.
P9
a. In case of incapacity to work
P9:(complete (a) or (b), delete the other)
15 Terms and conditions relating to sickness or injury and any provision for sick pay
or
b. Particulars of any terms and conditions relating to incapacity to work due to sickness or injury, including any provision
for sick pay, can be found in
or
16 Refer to provisions of some other document which the employee has reasonable opportunities of reading in the course of
his or her employment or which is made reasonably accessible to him or her in some other way
P10
a. Particulars of pensions and pension schemes are
P10:(complete (a) or (b), delete the other)
17 Particulars
or
b. Particulars of terms and conditions relating to pensions and pension schemes, can be found in
or
18 Refer to provisions of some other document which the employee has reasonable opportunities of reading in the course of
his or her employment or which is made reasonably accessible to him or her in some other way
P11
a. The amount of notice of termination of your employment you are entitled to receive is
P11:(complete (a) or (b), delete the other)
19 Period of notice
The amount of notice you are required to give is
20 Period of notice
or
b. Particulars of the amount of notice of termination of your employment you are entitled to receive and are required to give
are given in
or
21 Refer to relevant legislation or the provisions of any collective agreement directly affecting the terms and conditions of the employment, which the employee
has reasonable opportunities of reading in the course of his or her employment or which is made reasonably accessible to him
or her in some other way
P12
a. Your employment is permanent - subject to 11 above, to general rights of termination under the law and to the following
P12:(complete (a) or (b), delete the other)
22 Details of any other rights of termination
or
b. Your employment is for a fixed term and expires on
or
23 Date
or
c. Your employment is temporary and is expected to continue for
or
24 Period of likely duration
This should only be used as an indication of the likely duration
P13
The collective agreements which directly affect the terms and conditions of your employment are
P13:
25 Details identifying the relevant agreements and indicating, where the employer is not a party, the persons by whom they
were made
P14
*a. You are not expected to work outside the UK (for more than one month)
P14:*delete (a) or (b) as appropriate 26 Delete words in brackets if they are inappropriate
or
*b. You will be required to work in
or
27 Details of work location outside the UK
for
28 Period of work outside UK, where more than one month
You will be paid in
29 Currency
and will be entitled to
30 Details of any additional remuneration payable to the employee, and any benefits to be provided, because he/she is required
to work outside the UK
The terms relating to your return to the UK are
31 Details
P15
a. The disciplinary rules which apply to you are
P15:(complete (a) or (b), delete the other)
32 An explanation of the rules
or
b. The disciplinary rules which apply to you can be found in
or
33 Refer to provisions of some other document which the employee has reasonable opportunities of reading in the course of
his or her employment or which is made reasonably accessible to him or her in some other way
P16
(for completion from 1 October 2004)
P16:(complete (a) or (b), delete the other)
a. The disciplinary and dismissal procedure which applies to you is
34 An explanation of the procedure
or
b. The disciplinary and dismissal procedure which applies to you can be found in:
or
35 Refer to provisions of some other document which the employee has reasonable opportunities of reading in the course of
his or her employment or which is made reasonably accessible to him or her in some other way
P17
If you are dissatisfied with any disciplinary (or, from 1 October 2004, dismissal) decision which affects you, you should
apply in the first instance to
P17:
36 Name of person application should be made to, or position held (eg supervisor)
P18
You should make your application by
P18:
37 Explain how applications should be made
P19
If you have a grievance about your employment you should apply in the first instance to
P19:
38 Name of person grievance should be raised with, or position held (eg personnel officer)
P20
You should make your application by
P20:
39 Explain how grievances are to be raised
P21
a. Subsequent steps in the firm's disciplinary (and from 1 October 2004, dismissal) and grievance procedures are
P21:(complete (a) or (b), delete the other)
40 An explanation of the steps
or
b. Subsequent steps in the firm's disciplinary and grievance procedures are set out in
or
41 Refer to provisions of some other document which the employee has reasonable opportunities of reading in the course of
his or her employment or which is made reasonably accessible to him or her in some other way
P22
A contracting-out certificate under the Pensions Schemes Act 1993 *is/is not in force for the employment this statement is being issued for
*delete as appropriate
42 For further information contracting out certificates, call 019122501501
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