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Registration Form Update
Date
Applicant Full Name
Date of Birth
NI Number
Professional Registration Number
Grade/Band
I confirm that Ever Nurse have my permission to request and obtain copies of payslips from my employer/ umbrella company/ personal service company and have my permission to make this available to third parties
I agree
I understand that any personal data held by Ever Nurse is liable to be inspected by the Care Standards Commission and/or any other authorised 3rd party including for any audits. Please select below if you do/do not agree for your personal data to be made available to any 3rd party without direct supervision from a member of staff from Ever Nurse or myself being present.
I agree
I agree to give Ever Nurse Recruitment permission carry out online DBS checks both annually or as required.
I agree
I confirm that I have received, read, and understood the Ever Nurse Locum Handbook and agree to adhere to its contents. I have also read and understood the terms and conditions of engagement with Ever Nurse. I understand that my Ever Nurse ID badge must be worn and visible at all times while on assignment. Should I leave Ever Nurse, I agree to return my ID badge promptly. I acknowledge that all patient records must be kept strictly confidential in accordance with the Data Protection Act 2018 and GDPR. I also agree not to disclose any confidential information to third parties without prior written consent.
I Confirm
I confirm that Ever Nurse have my permission to generate and complete my share code check for my right to work
I Confirm
I agree for Ever Nurse to complete checks on my professional registration licence where required.
I Agree
I agree that I will maintain my Right to Work status and inform Ever Nurse should this change at any stage of my registration.
I Agree
I agree that I will adhere to the restrictions of my Right to Work status where applicable.
I Agree
I agree to inform Ever Nurse should I be subject to any investigation or Fitness to Practice whilst registered.
I Agree
Next of Kin Full Name
Relationship
Next of Kin Contact Number
Address
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Country
Do you hold a British Passport?
Yes
No
Are you an EU citizen?
Yes
no
Passport Number
Passport Expiry Date
Do you hold any of the following?
Working Holiday Visa
UK Residency Visa
Student Visa
Working Permit
Declaration
I declare that the answers to the above questions are true and complete to the best of my knowledge and belief.
Current Address
Street address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Contact Number
Applicant Email Address
Declarations
In line with the Government legislation under the terms of the “Working Time Regulations” we recommend that your working hours should not exceed 48 hours per week (averaged over a 17 week period.)
I confirm that I wish to work more than 48 hours per week
Should you wish to waive this right, please confirm by ticking above:
I confirm that Ever Nurse have my permission to forward my CV and personal data (for e.g. occupational health details, DBS check) for vacancies that satisfy my requirements as stated above and I give permission to check my DBS online service annually.
I agree
I give Ever Nurse permission to forward my CV to agreed clients for the purpose of obtaining employment.
I agree
I give Ever Nurse permission to apply for my references for the purpose of obtaining employment.
I agree
Equal Opportunities Policy
As an Equal Opportunities employer, Ever Nurse welcomes applications from suitably qualified individuals from all sections of the community. We are committed to creating a working environment that promotes equality of opportunity and is free from discrimination on the grounds of race, nationality, religion, gender, social background, family responsibilities, marital status, sexual orientation, age, disability, or special needs.Our Directors uphold best practices in Equal Opportunities, driven by ethical responsibility, sound business principles, and the understanding that certain forms of discrimination are unlawful. This is a core value at Ever Nurse, and we expect all employees and candidates to actively support it.To ensure the effectiveness of this policy, detailed monitoring is essential, which requires the collection of specific information. The data provided on this form will be kept confidential, will not be seen by those involved in the selection process, and will be used solely for statistical and monitoring purposes. It will not influence any part of your job application.
Ethnicity
Criminal Record Declaration
Yes
No
Under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, applicants for locum medical roles are not permitted to withhold information about convictions that may be considered 'spent' in other circumstances. Therefore, you are required to inform Ever Nurse in writing of any past or future criminal convictions.
Ever Nurse
I confirm that I have received, read, and understood the contents of the Ever Nurse Handbook and agree to abide by its guidance.
I confirm that I have received, read, and understood the terms and conditions of engagement with Ever Nurse.
I understand that my Ever Nurse ID badge must be worn and visible at all times while on assignment, and I agree to return the badge if I leave the organisation.
I give consent for my personal data to be shared with relevant third parties without the need for direct supervision by myself or a member of the Ever Nurse team.
I agree
Applicant/Candidate's Email
Date
Thank you! Your submission has been received!
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