Dental Nurses Pack

Registration Form
PERSONAL DETAILS

Please complete the whole form in BLOCK CAPITALS

Title	:
Surname	:
Other Name (s)	:
Date of Birth	:
Speciality/Grade	:

First Name	:
Maiden Name	:
National Insurance No.	:
Payroll No. Office Use)	:
DNC Pin No	:

Please enclose 2 recent passport style photographs of yourself for production of an identity badge

Current Address	:
Postcode	:

Home No	:
Work No	:
Mobile No	:
Pager No	:
Other No	:
Email	:

NEXT OF KIN

Mr / Mrs / Ms*
Name	:
Address	:
Postcode	:
1-Contact No	:
2-Contact No	:
Relationship	:

Mr / Mrs / Ms*
Name	:
Address	:
Postcode	:
1-Contact No	:
2-Contact No	:
Relationship	:

NATIONALITY AND ELIGIBILITY TO WORK

Do you have immigration permission to work in the UK?

Yes No

In line with Home Office guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by Simmans Medical the trading name of Simmans Recruitment Limited for temporary / permanent work.

Do you hold a British Passport?	:	Yes No
Are you an EU Citizen?	:	Yes No
Passport expiry date	:

Nationality	:
Passport Number	:

Do you hold any of the following visas

YES

ISSUE DATE

EXPIRY DATE

Working Holiday Visa

UK Residency Visa

Student Visa

Work Permit

Please provide details if Other

EDUCATIONAL QUALIFICATIONS AND TRAINING

Name of School/ College/University/Institute

Address

Year

From

Subjects & Grades Passed

PROFESSIONAL QUALIFICATIONS AND TRAINING

List all professional qualifications held and training courses undertaken, including Post Graduate Diploma / Courses etc. Professional qualifications and training will be verified. Continue on a separate sheet if necessary. Please provide certified copies / Originals of all certificates.

Qualification	Place where obtained	From (Month/Year)	To (Month/Year)

Please indicate the dates of training for the following courses (if completed):

Course	Date	Course	Date
Basic Life Support		Fire Health & Safety
Manual Handling		Food and Hygiene
Infection Control and COSHH
Please state if not specified:

EMPLOYMENT HISTORY

Please list details of your previous employments. It is important that you explain any gaps of employment of over 1 month in duration, continue on a separate sheet if necessary, starting with the most recent FIRST. In addition please attach your current CV.

Employer name, location & telephone no	Position held	Date from	Date to	Reason for leaving

Write a brief description of your present duties and responsibilities in the box below:

PROFESSIONAL REFEREES

Please supply two Professional Referees, one must be from your immediate or last employer and one must be relevant to the position applied for and both must have held a more senior position than yourself. This may include another Recruitment Agency if you have been undertaking locum positions recently.

Mr / Mrs / Ms*
Employer	:
Address	:
Postcode	:
Contact Name	:
Position	:
Telephone No	:
Fax No	:
Email	:

Mr / Mrs / Ms*
Employer	:
Address	:
Postcode	:
Contact Name	:
Position	:
Telephone No	:
Fax No	:
Email	:

Can we contact your referees immediately? Yes No
(Please be advised it is our company policy to obtain references before placement of work)

WORK REQUIREMENTS

Please complete the whole form in BLOCK CAPITALS

Date available to start work

Finishing date? (If known)

Would you consider a permanent position?

Yes No

Temporary position?

Yes No

Are you available for the following? (Please tick):

Full Time	Yes No
Part Time	Yes No
Days	Yes No
Nights	Yes No
Weekends	Yes No
Evenings	Yes No

Do you hold a valid UK Driving Licence? Yes No

Where is your nearest Public Transport?

Dates unavailable for work (e.g. holidays):

State which geographical area of the UK you prefer to work?

How far would you be able to travel, within the time of the following:

Within 1hr 1 ½ hr 2hr

Do you have use of a Car? Yes No

Please state below how you would describe yourself, i.e. personal qualities, performance, etc)

How did you hear about Simmans Medical? (E.g. by Referral, Internet sites, Job boards, Telephone Directories etc.)

If you do not wish to receive work opportunities via SMS text or email please tick this box:

PROFESSIONAL DETAILS

PROFESSIONAL MEMBERSHIP / PROFESSIONAL INDEMNITY INSURANCE:
Indicate which organisation you belong to and enclose a copy of your card or policy certificate

Name / Body	Membership No	Expiry Date

Name / Body	Membership No	Expiry Date

SKILLS CHECK LIST

PRCATICAL AND ETHICAL CONSIDERATIONS
handle patient complaints
ensure that patients' rights are protected
provide appropriate care for vulnerable patients
confront issues concerning treatment planning and the practice of medicine and dentistry within the context of limited financial resources
maintain confidentiality
deal with gender and racial issues
deal with colleagues failing their professional responsibilities
providing sufficient information about conditions and possible treatments
responding to questions
knowing who is the most appropriate person to give consent
gaining consent in emergencies
establishing a patient's capacity to give consent
statutory requirements that may need to be taken into account
gaining valid consent
Educating patients on oral health care
Examining teeth
Diagnosing patients' dental conditions
Use of X-rays
Assessing treatment options and agreeing treatment plans with patients
Carrying out agreed clinical treatments, such as restoring teeth affected by decay, crown and bridge work, etc;
maintaining patients' dental records
recruiting, training and managing staff
managing budgets and maintaining stocks of equipment
keeping abreast of new developments through a structured continuous professional development (CPD) programme
marketing services to potential clients.
KNOWLEDGE AND UNDERSTANDING
the scientific basis of dentistry, including the relevant biomedical sciences, the mechanisms of knowledge acquisition, scientific method and evaluation ofevidence
behavioural sciences and communication
disease processes such as infection, inflammation, disorders of the immune system, degeneration, neoplasia, metabolic disturbances and genetic disorders
the principles of health promotion and disease prevention
SKILLS
obtain and record a comprehensive history, perform an appropriate physical examination, interpret the findings and organise appropriate further investigations
ORTHODONTICS
carry out orthodontic assessment
identify treatment needs
understand the role of orthodontics in overall patient care
recognise and describe developing and manifest malocclusions
understand the appropriate timing of interventions and what these interventions are likely to be

undertake a range of clinical procedures which are within a dentist's area of competence, including techniques for preventing and treating oral and dentaldiseases and disorders
communicate effectively with patients, their families and associates, and with other health professionals involved in their care
share with patients provisional assessment of their problems and formulate plans for their further investigation and management
apply evidence-based treatment
acquire a wide range of skills, including research, investigative, analytical, problem-solving, planning, communication, presentation and team skills
use contemporary methods of electronic communication and information management
ATTITUDES
approaches to teaching and learning that are based on curiosity and exploration of knowledge rather than its passive acquisition
a desire for intellectual rigour, a capacity for self-audit and an appreciation of the need to participate in peer review
an awareness of personal limitations, a willingness to seek help as necessary, and an ability to work effectively as a member of a team
respect for patients and colleagues that encompasses, without prejudice, diversity of background and opportunity, language and culture
an understanding of patients' rights, particularly with regard to confidentiality and informed consent, and of patients' obligations
an awareness of moral and ethical responsibilities involved in the provision of care to individual patients and to populations
integrity, honesty and trustworthiness
an understanding of audit and clinical governance
an awareness that dentists should strive to provide the highest possible quality of patient care at all times
an awareness of the importance of his or her own health and its impact on the ability to practise as a dentist
an awareness of the need to limit interventions to the minimum necessary to achieve the desired outcomes
an awareness of the need for continuing professional development allied to the process of their continuing professional development, in order to ensure thathigh levels of clinical competence and knowledge are maintained
HEALTH AND SAFETY
adhere to health and safety legislation as it affects dental practice
understand the legal basis of radiographic practice
implement and perform satisfactory infection control and prevent physical, chemical or microbiological contamination in the practice of dentistry
arrange and use the working practice environment in the most safe and efficient manner for all patients and staff
see and assist in the delivery of all forms of orthodontic treatment
make safe all forms of orthodontic appliances
know when and how to refer for specialist advice
recognise and manage those problems of the mixed dentition where interceptive treatment is indicated, including space maintenance

NURSING SPECIALITIES / EXPERIENCE

WHICH SPECIALITIES DO YOU HAVE EXPERIENCE IN?

ORTHODONTICS
CLINICAL ENVIRONMENT
BIOMEDICAL SCIENCES
ACCIDENT AND EMERGENCY SERVICES
RESTORATIVE DENTISTRY
DENTAL IMPLANTS

DENTAL BIOMATERIALS SCIENCE
CHILD DENTAL HEALTH
PAEDIATRIC DENTISTRY
ORTHODONTICS
DENTAL PUBLIC HEALTH
COMPREHENSIVE ORAL CARE
OTHER

Please provide details if other :

I declare that all the information I have given in the check list and Nursing Specialist / Experience is true and correct to the best of my knowledge.

Signature

Print Name

REHABILITATION OF OFFENDERS ACT

*Certain types of employment and professions are exempt from the Rehabilitation of Offenders Act 1974 and in those cases particularly where the employment is sought in relation to positions involving working with children or vulnerable adults, details for all criminal convictions must be given. The information given will be treated in the strictest of confidence and only taken into account where, in the reasonable opinion of Simmans Medical the offence is relevant to the post to which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light.

		YES	NO
1.	Have you ever been convicted by the courts or cautioned, reprimanded or given a warning by the Police? (Note that the work you have applied for is exempt from the Rehabilitations of Offenders Act 1974, which means that all convictions. cautions, reprimands and final warnings on your criminal record need to be disclosed)
2.	Are you aware of any Police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post?
3.	Have you ever had an Enhanced Criminal Records Bureau Check?
4.	Have you ever had a Police check in another country? If so please provide details below and enclose a copy if held.

If you have answered YES to any of the above, please give details.

As part of your registration process, it is mandatory and standard practice for all nurses to complete and undertake a CRB check enhanced level with POVA and POCA.

EQUAL OPPORTUNITIES ACT

Simmans Medical is committed to a policy of equal opportunities for all work seekers and shall adhere to such a policy at all times and will review on an on-going basis on all aspects of recruitment to avoid unlawful or undesirable discrimination. We will treat everyone equally irrespective of sex, sexual orientation, marital status, age, disability, race, colour, ethnic or national origin, religion, political beliefs or membership or non-membership of a Trade Union and we place an obligation upon all staff to respect and act in accordance with the policy.

Simmans Medical shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment, or in any terms of employment or terms of engagement for temporary workers. And will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualification and ability to perform the relevant duties required by the particular vacancy.

DISABILITY DISCRIMINATION ACT

The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought.

Do you have any health issues or a disability relevant to the position or role you seek? YES No
(Please delete clearly as appropriate)

If yes, please specify :

If you have a disability, what are your needs in terms of reasonable adjustments to enable you to perform the role sought?

If you have a disability, what are your needs in terms of reasonable adjustments in order to access this recruitment service and to attend interview, or to take aptitude tests etc?

INSPECTION AND DATA PROTECTION ACT

As part of the inspection process under the Care Standards Act 2000, the local Registration and Inspection team has access to your personal file held at our office. Simmans Medical ensures to maintain the correct information required under the Care Standards Act. We require your consent for inspectors to view your file.

Signature

Print Name

THE WORKING TIME REGULATIONS 1998

The Working Time Regulations 1998 (‘The Regulations’) required the Company to limit your average weekly working time to 48 hours unless you agree with the Company that the limit shall not apply to you.

The Company wishes to have an agreement with you. It proposes an agreement (which will apply until terminated by notice) on the basis that:

1.	The 48-hour limit on average weekly working time will not apply to you;
2.	You may terminate the agreement (so that the 48-hour time limit would apply to you)by giving the person at the Company to whom you usually report 4 weeks’ written notice

Under the Regulations, the Company must keep records relating to your working time. This is the case whether or not you reach an agreement with the company about waiving time limits.

If you accept the Company’s proposal, please sign below. This document will then be the record of an agreement between you and the Simmans Medical.

Signature

Print Name

DOCUMENTS TO BE COMPLETED AND ENCLOSED

Please attach the following documents (tick when enclosed):

	Yes/No		Yes/No
Completed Registration Form	Yes No	Terms for Temporary Worker	Yes No
Completed Occupational Health Questionnaire and relevant laboratory Reports etc. (in sealed envelope)	Yes No	Completed Bank Details Form	Yes No
Updated CV	Yes No	2 passport size photographs	Yes No

ORIGINAL DOCUMENTS TO BE PROVIDED AT INTERVIEW

	Yes/No		Yes/No
Passport	Yes No	Documents re. eligibility to work in the U.K. issued by the Home Office	Yes No
National Insurance number / Card	Yes No	Professional Membership and DNC Pin card / certificate	Yes No
Name, address & contact details (Tel, Fax, Email) of two referees.	Yes No	Certificates of Professional Qualifications & Mandatory training courses (e.g. Manual Handling, Health & Safety)	Yes No
Payment for CRB Enhanced Disclosure	Yes No	2 proof of identity (i.e. Driving licence / Passport)	Yes No
2 proof of address (i.e. Utility Bills / Bank Statement)	Yes No

Please Note: Original documents MUST be taken to the interview for verification and for the processing of CRB check enhanced level with POVA and POCA check.

DECLARATION

I acknowledge that I have been given a copy of the terms and conditions of service issued Simmans Medical the trading name of Simmans Recruitment Limited, which is mine to keep, and furthermore that I have read those terms and conditions and agree to abide by them.

I declare that I will hereby inform Simmans Medical the trading name of Simmans Recruitment Limited of any changes in my health circumstances which may affect my ability to work whilst registered with Simmans Medical.

I am not aware of any condition, medical or otherwise, which would affect or limit my employment or performance, other than those declared in my Occupational Health Form.

I am permitted to work in the UK. I understand that my registration is subject to the receipt of at least two satisfactory references and enhance disclosure from the Criminal Records Bureau.

I appoint Simmans Medical to undertake my CRB Enhance disclosure; however, charges are to be borne by me.

I declare that the information given herein is true and complete and is not presented in a way intended to mislead. I agree that if I have given false or misleading information or omit to give relevant information now or in the future, that Simmans Recruitment Ltd T/A Simmans Medical may cease to offer me further agency placements without notice, as well as a claim for recovery of any payments I have received, together with a claim for loss of profit to Simmans Medical.

I acknowledge that my personal details will be stored and handled correctly by Simmans Medical in accordance with the Data Protection Act 1988, however, I agree that they may be made available for audit by the relevant Government Organisations, e.g. NHS PASA or the National Care Standards Commission

I undertake to inform Simmans Medical immediately if I am engaged through introduction, or if during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Simmans Medical will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client).

I agree to respect the confidentiality of patients and any other information I may have access to, at any time.

Signature	:
Date	:

Print Name	:
DNC Pin Number	:

*******************************************************************************************************************************************************

I acknowledge that I have been given an application pack for the General Dental Council in becoming a registered dental care professional, by Simmans Medical the trading name of Simmans Recruitment Limited, which is mine to keep and understand. I shall complete and return my application for registration to: Registration Department, General Dental Council, 37 Wimpole Street, London, W1G 8QD; Telephone: 0207 224 3294; Email: information@gdc-uk.org; Website: www.gdc-uk.org

Signature	:
Date	:

Print Name

CONTRACT FOR SERVICES FOR TEMPORARY WORKERS
(TERMS OF ENGAGEMENT)

1. DEFINITIONS

1.1. In these Terms of Engagement the following definitions apply: –

“Assignment”	means the period during which the Temporary Worker is supplied to render services to the Client;
“Client”	means the person, firm or corporate body requiring the services of the Temporary Worker together with any subsidiary or associated company as defined by the Companies Act 1985;
“Employment Business”	means Simmans Medical of 109 Church Street, Croydon, Surrey, CR0 1RN
“Temporary Worker”	means the trained nurse, or other temporary worker who agrees to and is provided with a copy of these terms of engagement.
“Relevant Period”	means the longer period of either 14 weeks from the first day on which the Temporary Worker worked for the Client, or 8 weeks from the day after the Temporary Worker was last supplied by the Employment Business to the Client.

      1.2. Unless the context otherwise requires, references to the singular include the plural and references to the masculine include the
             feminine and vice versa.

      1.3. The headings contained in these Terms are for convenience only and do not affect their interpretation.

2. THE CONTRACT

2.1	These Terms constitute a contract for services between the Employment Business and the Temporary Worker and they govern all Assignments undertaken by the Temporary Worker. However, no contract shall exist between the Employment Business and the Temporary Worker between Assignments.
2.2	For the avoidance of doubt, these Terms shall not give rise to a contract of employment between the Employment Business and the Temporary Worker. The Temporary Worker is engaged as a self-employed worker, although the Employment Business is required to make statutory deductions from the Temporary Worker’s remuneration in accordance with clause 4.1
2.3	No variation or alteration of these Terms shall be valid unless approved by a director of the Employment Business in writing.

3. ASSIGNMENTS

3.1	The Employment Business will endeavour to obtain suitable Assignments for the Temporary Worker to work in fields specified by the Temporary Worker on his/her application forms (updated as necessary). There is no charge for this work finding service although the Employment Business does, from time to time, provide services for which a charge is made. Details of these are available on request. Provision of work finding services is not conditional on use of any of the Employment Business’ chargeable services.
3.2	The Temporary Worker acknowledges that the nature of temporary work means that there may be periods when no suitable work is available and agrees: that the suitability of the work to be offered shall be determined solely by the Employment Business; that the Employment Business shall incur no liability to the Temporary Worker should it fail to offer opportunities to work in the above category or in any other category; and that no contract shall exist between the Temporary Worker and the Employment Business during periods when the Temporary Worker is not working on an Assignment.
3.3	At the same time as an Assignment is offered to the Temporary Worker the Employment Business shall inform the Temporary Worker of the identity of the Client, and if applicable the nature of their business; the date the work is to commence and the duration or likely duration of the work; the type of work, location and hours during which the Temporary Worker would be required to work; the rate of remuneration that will be paid and any expenses payable by or to the Temporary Worker; and any risks to health and safety known to the Client in relation to the Assignment and the steps the Client has taken to prevent or control such risks. In addition the Employment Business shall inform the Temporary Worker what experience, training, qualifications and any authorisation required by law or a professional body the Client considers necessary or which are required by law to work in the Assignment.
3.4	For the purpose of calculating the average number of weekly hours worked by the Temporary Worker on an Assignment, the start date for the relevant averaging period under the Working Time Regulations shall be the date on which the Temporary Worker commences the first Assignment.
3.5	The Temporary Worker shall not be obliged to accept any Assignment offered by the Employment Business
3.6	For the purpose of calculating the average number of weekly hours worked by the Temporary Worker on an Assignment, the start date for the relevant averaging period under the Working Time Regulations shall be the date on which the Temporary Worker commences the first Assignment.
3.7	The Temporary Worker may not under any circumstances introduce any other person to supply services in place of the Temporary Worker.
3.8	If during the course of an Assignment or within certain periods after the end of an Assignment or after an introduction where no assignment took place the Client wishes to employ the Temporary Worker direct (or assist another body to employ the Temporary Worker direct), the Temporary Worker acknowledges that under certain circumstances the Employment Business will be entitled either to charge the Client an introduction fee or a period of extended hire.

4 REMUNERATION

4.1

Unless otherwise agreed the Employment Business shall pay to the Temporary Worker remuneration calculated at the hourly rate as displayed in the Employment Business’ pay rate schedules (available on request) Where such schedules indicate a range of hourly rates (the lower end of the range being the minimum hourly rate payable) the Employment Business will decide on the rate according to a range of factors. The actual rate will be notified on a per Assignment basis, for each hour worked during an Assignment (to the nearest quarter hour) to be paid weekly in arrears for all work satisfactorily performed, subject to PAYE, National Insurance and any other deductions which the Employment Business may be required by law to make.

4.2

Subject to any statutory entitlement under the relevant legislation, the Temporary Worker is not entitled to receive payment from the Employment Business or Clients for time not spent on Assignment, whether in respect of holidays, illness or absence for any other reason.

5 STATUTORY LEAVE

5.1	For the purposes of calculating entitlement to paid annual leave pursuant to Working Time Regulations 1998 under this clause, the leave year commences 1st April annually.
5.2	Under the Working Time Regulations 1998, the Temporary Worker is entitled to 4 weeks’ paid leave per leave year. All entitlement to leave must be taken during the course of the leave year in which it accrues and none may be carried forward to the next year.
5.3	Entitlement to payment for leave accrues in proportion to the amount of time worked continuously by the Temporary Worker on Assignment during the leave year and is calculated according to the previous 12 weeks worked.
5.4	In the course of any assignment during the first leave year the Temporary Worker is entitled to request leave at the rate of one twelfth of his total holiday entitlement in each month of his leave year. Where the Temporary Worker wishes to take any leave to which he is entitled, he should notify the Employment Business in writing of the dates of his intended absence. The Employment Business requires four weeks’ written notice of intention to take holiday. This is to be sent to the holiday manager in the payroll department at Simmans Medical, 109 Church Street, Croydon CR0 1RN.
5.5	None of the provisions of this clause regarding the statutory entitlement to paid leave shall affect the Temporary Worker’s status as a self-employed worker.
5.6	Temporary Workers who provide their services via an intermediary organisation or on a self-employed basis are not entitled to holiday pay.
5.7	No person shall be able to work for the Employment Business whilst on annual leave.

6 SICKNESS ABSENCE

6.1	6.1 The Temporary Worker may be eligible for Statutory Sick Pay provided that s/he meets the relevant statutory criteria.

7 TIME SHEETS

7.1

At the end of each week of an Assignment (or at the end of the Assignment where it is for a period of one week or less or is completed before the end of a week) the Temporary Worker shall deliver to the Employment Business a time sheet duly completed to indicate the number of hours worked during the preceding week (or such lesser period) and signed by an authorised representative of the Client. Failure to submit a time sheet for hours worked may delay payment for those hours. Failure to co-operate in the Employment Business’ timesheet process may constitute a breach of this contract for which damages might be claimed. For prompt payment Timesheets are to be in by Monday 12:00pm

7.2

For the avoidance of doubt and for the purposes of the Working Time Regulations, the Temporary Worker’s working time shall only consist of those periods during which he is carrying out activities or duties for the Client as part of the Assignment. Time spent travelling to the Client’s premises, lunch breaks and other rest breaks shall not count as part of the Temporary Worker’s working time for these purposes.

8 CONDUCT OF ASSIGNMENTS

8.1

The Temporary Worker is not obliged to accept any Assignment offered by the Employment Business but if he/she does so, during every Assignment and afterwards where appropriate, he/she will: –

a)	Co-operate with the Client and/or the Client’s staff, accept reasonable instructions and accept the direction, supervision and control of any responsible person in the Client’s home or organisation;
b)	Be present at such times as may be stipulated by the Client and unless arrangements have been made to the contrary, to conform to the normal hours of work agreed at the premises where the assignment is to be carried out;
c)	Observe any relevant rules and regulations of the Client’s establishment (including normal hours of work) to which attention has been drawn or which the Temporary Worker might reasonably be expected to ascertain;
d)	Take all reasonable steps to safeguard his or her own health and safety and that of any other person who may be present or be affected by his or her actions on the Assignment and comply with the Health and Safety policies and procedures of the Client and the Employment Business;
e)	Not engage in any conduct detrimental to the interests of the Client;
f)	Not at any time divulge to any person, nor use for his own or any other person’s benefit, any confidential information relating to the Client’s or the Employment Business’ employees, business affairs, transactions or finances;
g)	Act in a professional and courteous manner;
h)	Be responsible for the provision of a uniform and any necessary equipment;
i)	Co-operate with the Employment Business’ staff and accept their direction, supervision and control

8.2

If the Temporary Worker is unable to attend work during the course of an Assignment he should inform the Client and the Employment Business by no later than 7.00am on the first day of absence to enable alternative arrangements to be made.

8.3

If, either before or during the course of an Assignment, the Temporary Worker becomes aware of any reason why he may not be suitable for an Assignment, he shall notify the Employment Business without delay.

9 TERMINATION

9.1	Before commencing any assignment the Temporary Worker must provide the Employment Business with confirmation that he has not been convicted of or cautioned in relation to any criminal offence. In the event that the Temporary Worker is charged with or cautioned in relation to any criminal offence he must inform the Employment Business immediately and provide regular reports about the progress of proceedings.
9.2	The Temporary Worker will fully co-operate with the Employment Business in relation to any criminal record checks which The Employment Business is required to carry out.
9.3	Before commencing any assignment the Temporary Worker must inform the Employment Business about any complaint made against him/her that is relevant to their professional competence, standing or conduct. In the event that the Temporary Worker becomes the subject of a complaint he/she must inform the Employment Business immediately and provide regular reports about the progress of proceedings.
9.4	The Employment Business will inform the Temporary Worker about any complaint made against him/her that is relevant to his/her professional competence or conduct.
9.5	Where the Temporary Worker wishes to raise any complaint about any matter, he/she should do so in accordance with the
9.6	Unless otherwise agreed the Employment Business or the Client may, without prior notice or liability, terminate the Temporary Worker’s Assignment at any time.
9.7	Unless otherwise agreed the Temporary Worker may terminate an Assignment at any time without prior notice or liability.
9.8	If the Temporary Worker does not inform the client or the Employment Business should they be unable to attend work during the course of an Assignment this will be treated as termination of the Assignment by the Temporary Worker unless the Temporary Worker can show that exceptional circumstances prevented informing the Employment Business of the absence.
9.9	If the Temporary Worker is absent during the course of an Assignment and the contract has not been otherwise terminated the Employment Business will be entitled to terminate the contract in accordance with clause 9.6 if the work to which the absent worker was assigned is no longer available for the Temporary Worker.
9.2	If the Temporary Worker is absent during the course of an Assignment and the contract has not been otherwise terminated the Employment Business will be entitled to terminate the contract in accordance with clause 9.6 if the work to which the absent worker was assigned is no longer available for the Temporary Worker.

10 SPECIAL PROVISIONS

10.1

The Temporary Worker must provide the Employment Business with all requested proof of qualifications, references, recent photographs (for identification purposes), access to health records and medical registrations as may be requested in order for the Employment Business to satisfy itself that the Temporary Worker is fit to be supplied to Clients. The Temporary Worker accepts that the Employment Business is or may be required to handle/process this (and other personal information as reasonably requested from time to time) and may need to share such information with its agents or third parties as part of performing its duties. The Temporary Worker recognises such obligations on the Employment Business and hereby consents to the handling, processing and divulging (whether in the UK, the European Union or elsewhere) of such information as may be necessary for the Employment Business (or its agents) to perform its duties.

10.2

The Temporary Worker accepts and co-operates with the Employment Business for any formalities that is required in obtaining a CRB check Enhance Level with POVA & POCA check.

10.3

In the situation where the Temporary Worker is a qualified nurse, the Nurse should ensure that her registration with the NMC remains effective at all times and that she complies with the NMC Professional Code of Conduct during every Assignment. In all cases Temporary Workers with professional qualifications and who rely thereon for agency work must ensure full and current compliance with the appropriate professional requirements.

10.4

The Temporary Worker is strongly recommended to effect professional indemnity insurance cover.

10.5

The Temporary Worker should advise the Employment Business immediately if offered any employment or engagement by the Client or any third party to whom she is introduced by the Client and is also requested to provide details to the Employment Business of any remuneration offered.

10.6

The Temporary Worker is required to advise the Employment Business of any medical condition or any change in state of health that could impact upon ability to carry out Assignments or her eligibility for Assignments.

10.6

The Temporary Worker must follow and co-operate fully with the formal induction procedure of the Employment Business and undertake any training specified by the Employment Business.

10.7

Throughout each Assignment, the Temporary Worker must comply with the Employment Business’ policies and/or procedures:

10.7.1	On standards of conduct and all organisational matters as set out in the Employment Business’s handbook;
10.7.2	on the safe handling of client money and property. In addition the Temporary Worker hereby agrees not to be involved in assisting in the making of or benefiting from the Will or Codicil of any patient whom the Temporary Worker is supplied by the Employment Business to assist, nor will the Agency Worker become involved in any other legal documentation concerning the Client’s affairs;
10.7.3	in relation to the entry and departure from Client’s home;
10.7.4	Which apply in the event of a non-response from the Client at the premises where the Assignment is to be performed or in the event of any accident or other emergency at the premises;
10.7.5	regarding the detailed records which the Agency Worker is required to maintain during an Assignment which shall be advised to the Agency Worker; and
10.7.6	6Which concern the administration of or assistance with medication (including all record keeping requirements) and which will also identify the limits to assistance and the tasks which may not be undertaken without specialist training.

10.8

At all times during an Assignment, the Temporary Worker shall wear an identification badge, which shall provide details of his/her name, which identifies the Employment Agency and which features a contemporary photograph of the Temporary Worker.

10.9

The Temporary Worker recognises the Employment Business’ obligations under The Conduct of Employment Agencies and Employment Businesses Regulations 2003 (the Regulations) and hereby agrees to disclosures of personal information about the Temporary Worker as required in order for the Employment Business to comply with the Regulations.

Address :

Date
Signed by Temporary Worker

11 LAW

a	These Terms are governed by the law of England & Wales and are subject to the exclusive jurisdiction of the Courts of England & Wales

Confirmation of Receipt

I hereby confirm that I have received and understood the above terms of Services. I understand that any arrangement outside of these terms must be notified to me in writing by the managers of the employment business.
Print Name:
Position /Grade:

Bank Details Form

Please Complete form in BLOCK CAPITALS

Job title	:
Forename	:
Surname	:
NMC Pin No	:

Payroll no (office use only)	:
Date of birth	:
National Insurance (NI) No	:

Bank Details

Bank / Building Society name	:
Bank /Building Society address	:
Postcode	:
Account holders name	:
Account number	:
Sort code	:
Building Society reference	:

Please ensure that this form is completed and returned with your Registration Form.

The above information is required by our Account Department and will enable them to process your salary without any complications.

Signature	:
Date	:

Print Name	: