Application Form

Please provide two document copies as proof of identification (e.g. household bill showing address, passport, etc). Plus two passport size photographs of yourself, signed on the back with details of your Registration number.

Please provide evidence of police clearance from your country of origin if you have entered this country within the past six months.

Rehabilitation of Offenders Act 1974 (exceptions) Order 1975.

Due to the nature of the work for which you are applying, the provision of Section 4 (2) of the Rehabilitation of Offenders Act 1974 does not apply by virtue of the Rehabilitation of Offenders Act 1974 (exceptions) Order 1975. Applicants are therefore NOT entitled to withhold information about convictions which for purposes are ‘spent’ under the provisions of the Act. In the event of employment, any failure to disclose such convictions will result in your removal from our register. Any information you may give will, of course, remain stricty confidential. CarePlus Healthcare may contact you for your permission to disclose such details if relevant to the position you are applying for.

Which of the following applies to you:

The Terms of engagement applicable to the tax status you select, can be found in the Locum Induction Handbook. Please advise your tax status as soon as possible. CarePlus Healthcare will be unable to process any payments to you until this is supplied.

The Working Time regulations 1998 (“The Regulations”) require CarePlus Healthcare to limit your average weekly working time to 48 hours unless you opt-out so that the limit shall not apply to you. CarePlus Healthcare wishes to have an agreement with you for the following:

Please advise by selection whether you give permission to CarePlus Healthcare, 7200 The Quorum, Oxford Business Park North Garsington Rd Oxford Ox4 2JZ to have access to your medical records pertinent to your immunisation and blood test history.

I the undersigned hereby declare that I have read and understood the CarePlus Healthcare Induction Handbook and that I am already trained to the NHS standards in all areas. In the event that I feel I require further training in any area I will inform CarePlus Healthcare without delay. I will ensure my annual Mandatory Training is updated and i will forward copies of certification to CarePlus Healthcare.

Some specialties will be required to wear uniform. If this relates to you please complete this section. Please ensure you have read and fully understand the terms and conditions in The Induction Handbook in relation to ID badges and Uniform.

Please be aware that you may be in breach of CarePlus Healthcare’s contractual and or Legal Requirements if you do not abide by these conditions. Any known breach may result in disciplinary action being taken. CarePlus Healthcare ensures that all its workers adhere to contractual and legal requirements at all times.

If ay any time you need clarification, please endeavour to contact your CarePlus Healthcare representative who will be happy to discuss these with you.

Measure the chest around the fullest part, placing the tape close up under the arms and ensuring it is well up at the back across the shoulder blades.

WARNING: It is an offence under The Fraud Act 2006 to deliberately make, or cause to make, a false or misleading statement, or conceal circumstances in relation to an application.

Please read the following carefully before signing:

• I declare that the information I have supplied in this application form is complete, truthful and correct in every detail.
• I have read the information in the Induction Handbook and the Terms of Engagement as applicable to me (in accordance with my tax status is Section 13 above) and I accept the Terms of Engagement.
• I acknowledge that if my tax status is as a limited company/PSC by signing this application for I will be signing on behalf of the limited company/PSC and I confirm that I am authorised to do so.
• I achnowledge and agree that by commencing an assignment (as defined in the Terms of Engagement) I will be confirming that I am willing to work in the position set out in the relevant Confirmation of Assignment Form and I acknowledge that the Terms of Engagement will be deemed to have been accepted by me upon my commencing an assignment.
• I acknowledge and agree that if my tax status at Section 13 changes I will notify CarePlus Healthcare and I will refer to the Induction Handbook for the Terms of Engagement applicable to my new tax status. I agree that by commencing an assignment following my change of tax status I will be deemed to have accepted the Terms of Engagement relevant to my new tax status upon my commencing the assignment.
• I understand that my selection against Access to Medical records at Section 16 will give/refuse permission for CarePlus Healthcare to have access to my medical records pertinent to my immunisation and blood test history.
• I understand that it is my responsibility to undergo an annual appraisal and to supply CarePlus Healthcare with relevant information in relation to this.
• I understand that it is my sole responsibility to update CarePlus Healthcare in the event of any disciplinary action, investigation or changes to my professional registration.
• I acknowledge that it is my sole responsibility to update CarePlus Healthcare in the event of any disciplinary action, investigation or changes to my professional registration.
• I understand CarePlus Healthcare nay collect, use and disclose my personal information to the authority, or any person, firm or organisation duly authorised on the authorities behalf for the purpose of Audit undertaken within the Framework agreements or otherwise in accordance with the Data Protection Act 1998 and I consent to the provisions of paragraph 1.5 of the Induction Handbook relating to use of my personal data.
• I agree that if I have given any false or misleading information, or do not give relevant information (including any change to the information I have previously provided) to CarePlus Healthcare now or during the course of an assignment, this may result in the termination of the assignment with immediate effect.

If any information supplied is later found to be false or misleading then CarePlus Healthcare may terminate employment with immediate effect and refer the matter to the relevant regulatory and or professional bodies.

All CarePlus Healthcare related companies (“CarePlus Healthcare”) including CarePlus Healthcare Group Ltd, Recruitment Express Ltd (trading as The Locum Consultancy), and Group 24 Ltd are each separate legal entities but are related through common ownership. Each specialises in temporary recruitment.

By signing this declaration, you agree to the Terms of Engagement for the purpose of temporary recruitment and the declaration laid out above for CarePlus Healthcare. This enables you to have access to work through all CarePlus Healthcare related companies.

Thank you for completing your application with CarePlus Healthcare. Please return this form and all supporting documentation to your dedicated CarePlus Healthcare recruitment consultant by hand, post, scan or email.