Example form of a written statement of employment particulars
URN No: 07/1102
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 dismissal decisions and for grievances;or
b) the method of application in both cases is the same.
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 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.
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| 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 |