New employee questionnaire

This form is for Officer use.

The NHS Pension Scheme legislation requires employers to contractually enrol all new eligible
employees into the NHS Pension Scheme on commencement of their employment. The Pensions
Act 2008 requires those employees who cannot join the NHS Pension Scheme to be automatically
enrolled into an alternative pension scheme. In order to ensure that you are correctly enrolled your
employer needs to establish your current NHS pension status. As part of the recruitment process,
all new employees, staff transferring in from another NHS employer and existing NHS employees
must complete this questionnaire as fully as possible.

Please note that the information provided will only be used for local and central pensions/payroll
administration purposes to determine your eligibility criteria to join the NHS Pension Scheme.

Please use the completion notes whilst completing the form.

Employer name

Your full name

Previous surname(s)

National Insurance number

Date of birth

What is your new job role / title HEALTH CARE ASSISTANT

Date new role will start

Have you ever had employment which is covered by the NHS Yes No *
Q1 Pension Scheme (agency work is not applicable)? Go to Q2 Go to Q10

Is this an employment that will continue at the same time as Yes No

Q2 your new role? Go to Q3 Go to Q5

Full Time Part Time Bank

Please indicate contract type of this other
Q3
employment(s)
Go to Q4 Go to Q4 Go to Q4
Important: If you change your hours or leave your other employment(s) it is your responsibility to
advise the Payroll team as this may affect your eligibility to a pension scheme.

New Employee Questionnaire (V11) 12.2015 1

 Please provide the name and contact details of your other employer(s), if necessary please
continue on a separate sheet.

Q4

Go to Q5

When you were previously a member of the NHS Pension Yes No

Q5 Scheme did you claim any retirement pension benefits? See elow 6
b Go to
Q

Please indicate which NHS retirement benefit you are in receipt of:

Ill Health Retirement (Early or Age) Drawdown (partial retirement)

Please indicate which Section or Scheme you were a member of:

1995 Section 2008 Section 2015 Scheme Not Known

Go to Q6

Have you previously been made redundant from an NHS Yes No

Q6 employment? See below
Go to
Q7

Date of redundancy / /

Yes No
Did you take an NHS Pension?
See below Go to Q7

Name of NHS employer made redundant from

Go to Q7

Do, or did you, have any NHS Money Purchase Additional

Voluntary Contribution (NHS MPAVC) arrangements in place Yes No
Q7 through the NHS Pension Scheme with Equitable Life, See below Go to Q8
Prudential or Standard Life?

Please contact your NHS MPAVC provider if you wish to continue to pay your additional
contributions. You will need to advise them of your new employer so they can provide
details for payroll deductions to continue. (Go to Q8)

Do you have an Added Years contract, NHS Additional No

Yes
Q8 Pension purchase or Early Retirement Reduction Buy Go to Q9
See below
Out (ERRBO) in place?

New Employee Questionnaire (V11) 12.2015 2

 If your answer is ‘yes’ please provide us with a copy of your contract. Go to Q9

In your new post will you be applying for Mental Health Officer Yes No
Q9 status (MHO)? See b elow Go Q10
to

If you had previous MHO status please provide the / /

date the role ended

If you did not have previous Mental Health Officer status then your new post will not qualify
for this status. (Go to Q10)

Do you have any previous pension rights that you might be Yes No *
Q10 interested in transferring into the NHS Pension Scheme? See below Go to Part
2

If your answer is ‘Yes’, your employer will provide you with our Transfer In Guide and application
pack. However, it is important to note that this can only be done in the first 12 months of joining the
Scheme for members of the 1995 Section, or within the first 12 months of becoming eligible to join
the 2008 Section. (Go to Part 2)

Part 2 Declaration
I confirm that I have completed the above form to the best of my ability and knowledge and
undertake to advise my payroll team in the event that I should alter the position stated above in
respect of employment with any other NHS organisations.

Signature Date 12-08-2023

Please make sure this form is provided to your payroll department by the commencement of your
employment to enable the correct assessment of your pension position.

The form should be returned to:

Employer stamp

New Employee Questionnaire (V11) 12.2015 3

Completion notes
These completion notes are provided to assist you in completing the new joiner questionnaire.

Please complete the questionnaire as fully as possible so that the correct assessment can be
made.

Part 1

Q1 – This question is to establish if you have any previous NHS Pension Scheme membership at
the date of starting this new employment.

Q2 – This is to establish whether you will have any other NHS employments at the same time as
your new role.

Q3 – It is important that your employer knows how many hours you work in your other
employment(s). Please make sure that you keep your employer/payroll informed if the situation
changes.

Q4 – If you are continuing to work in another NHS post we need to know who your other NHS
employment is with. This is important as there are reasons why you may not be eligible for the NHS
Pension Scheme in two employments. The name of your other employer may be the same as the
one you are starting with. Please note that if you are working for an NHS organisation through an
employment agency, this does not count as NHS employment.

Q5 – If you have or are in receipt of any NHS pension benefits then you may not be eligible to
rejoin the NHS Pension Scheme. However, by providing the information requested we will be able
to make the correct assessment. We ask you to identify which Section or Scheme you were in
(1995 Section, 2008 Section or 2015 Scheme) but if you are unsure then please tick the ‘Not
known’.

Q6 – NHS service that has been counted in the calculation of a redundancy payment needs to be
declared to ensure the correct assessment of your service. If you are in receipt of an NHS Pension
as the result of redundancy, this will impact the assessment.

Q7 – If you have Additional Voluntary Contribution (AVC) arrangements with either Equitable life,
Prudential or Standard Life through the NHS Pension Scheme then you need to advise the AVC
provider that you are changing employer to ensure continuity of the arrangement.

Q8 – If you have either Added Years, Additional Pension purchase or Early Retirement Reduction
Buy Out (ERRBO) through the NHS Pension Scheme it is essential that you confirm the details and
provide a copy of the contract that was provided to you when you commenced the arrangement to
ensure continuity of the arrangement.

Q9 – Please note that MHO status no longer applies to any post commenced after 6 March 1995.
However, if you have previously held a post (in the last five years) that attracted Mental Health
Officer (MHO) status and you believe the new post also qualifies for MHO status then you need to
indicate this by ticking ‘Yes’ and completing the details of the previous employment.

New Employee Questionnaire (V11) 12.2015 4

Q10 – You may be able to transfer other pensions into the NHS Pension Scheme, however it is
important to note that this can only be done:

• in the first 12 months of joining the Scheme if you are member of the 1995 Section

• within the first 12 months of becoming eligible to join the 2008 Section.

If you would like to consider your option to transfer benefits, please tick the ‘Yes’ box and a
Transfer In Guide and application pack will be given to you. If you say no but decide at a later date
that you wish to consider a transfer (within the 12 month deadline) then you can obtain the
Transfer In Guide and application pack from your employer or the NHS Pensions website
(www.nhsbsa.nhs.uk/pensions). If you have previous NHS pension membership within England
and Wales this will be automatically added to any new membership in the NHS Pension Scheme.

Once the assessment has been made, you will be notified by your employer by the first pay day
which Scheme you have been enrolled in, what the Scheme features are, the contribution rates
and your options.

Assessment is not possible until your first payment is made.

New Employee Questionnaire (V11) 12.2015 5