Sensible Locums | Quality Locums UK

ONLINE CANDIDATE REGISTRATION

Sensible Locums aims to make the registration process easier, with this in mind this form has been created.
Take a few moments to complete this form and if possible attach your CV, then one of our consultants will
get back to you as soon as possible. If you have any queries please contact us on 0800 019 4112.

Application

Profession

Speciality

Personal Details

Title
Surname
Forename
Gender	Male Female
Date of Birth
Marital Status
Previous Surname
National Ins. No.
Nationality

Address (Perm)
Postcode
Address (Current)
Postcode
Home Number
Work Number
Mobile Number
Fax Number
Email Address

Right to work

Document Type

Passport No.
Expiry Date

Next of Kin

Title
Surname
Forename(s)

Address
Postcode
Telephone Number

Requirements

Available for (tick as appropriate)		Full Time Part Time Evenings
Available from
Working full time? What is your notice period?
Geographical areas of the UK you prefer to work in
Would you live in Hospital Accommodation?		YES NO
Do you have a valid UK driving license?		YES NO
Current Pay Rate		£
Additional Notes

Professional Qualifications

University	Training Institution	Qualification	Date of Graduation

Continued Professional Development

Course Attended	Location	Date

Professional Registration

Member of which Professional Body eg RPSGB/HPC

Member Number

Expiry

Work Experience

Please complete giving your most recent employment first and then continue to cover your last 10 years. You may need to continue on additional notes (this must contain all dates including study and travel periods).

Employers name	Grade/Speciality	Date	Duties/Notes
		to
		to
		to
		to

Additional Notes

References

Please give name and address of two work related referees, one must be your last employer.

Full name
Position
Organisation
Address
Postcode
Telephone Number
Email Address

Full name
Position
Organisation
Address
Postcode
Telephone Number
Email Address

I give consent for Sensible Locums Ltd to approach the references supplied. YES NO

AIDS/HIV infected healthcare workers

I confirm that I am aware of the Department of Health’s guidelines on AIDS/HIV infected healthcare workers and agree to abide by them. YES

DECLARATION

Rehabilitation of Offenders Act 1974

You are required to disclose details of any criminal record. Please list your convictions and their dates below, this information will be taken into account where the offence is relevant to the post for which you are applying. Therefore disclosure need not result you from being excluded from obtaining this position. The nature of work you are applying for is exempt from the provision of section 4(2) of the Rehabilitation of Offenders Act 1974 Exceptions Order 1975). Applicants are therefore, not entitled to withhold any information about convictions, even if they are regarded as "spent" convictions under the provisions of this act. Failure to declare a conviction may require us to exclude you from Sensible Locums Ltd. register or terminate an assignment if the offence is not declared but later comes to light.

Have you ever been convicted of an offence other than Road Traffic Violation YES NO

If Yes, please give details

Police Checks/CRB checks

Most Employers request either a Police Record Check or a CRB check for all medical staff, regardless of the position and responsibilities you will undertake.

Do you have a Police or CRB check? YES NO
If no, please give date moved into current accommodation to allow Sensible Locums to conduct a CRB check.

Professional Misconduct

Have you ever been subject of professional misconduct proceedings or any such proceedings pending of threatened against you? YES NO

If Yes please give details:

Working Time Regulations

The Working Time regulations 1998 stipulate that employers will limit your average weekly working time to 48 hours unless you agree to work outside that limit. Sensible Locums wishes to have an agreement with you. It proposes an agreement on the basis that:

1. The 48 hour limit on average weekly time will not apply to you.
2. You may terminate this agreement by providing Sensible Locums written confirmation (4 weeks notice period).
3. Upon the expiry of the notice period the working week limit shall apply with immediate effect.

Sensible Locums is obliged to maintain up to date records relating to your working time. This is the case whether or not you take up this agreement to waiver your working time limits.

I hereby agree that the Working Week Limit shall not apply

YES NO

Submit CV

In order for Sensible Locums to process your application correctly, we will require an up to date copy of your CV.
You can submit your CV as an attachment below or fax it to us on 020 8364 9966 or send via post to:

Freepost RLSK-TCGH-RZKZ
Sensible Locums Ltd
Castle House
21 Station Road
BARNET, EN5 1PL

Sensible Locums will treat this information given as confidential and will only disclose details to third parties for the purposes of finding a suitable position.

I also agree to abide by Sensible Locums Terms & Conditions and give consent to the making of a Criminal Record Disclosure check.

I declare that the information given as well as any documentation forwarded on (including Curriculum Vitae) is accurate and that I will immediately notify Sensible Locums of any changes. I agree if I have given false information or have refused to submit certain documentation now or in the future, it may result in instant dismissal from an assignment, as well as a claim for any payments to be received and the possibility of a claim from Sensible Locums Ltd for any loss of profits incurred.

To agree to the above statement please tick here (your application will not be submitted if this is not ticked)

If you are a PAYE candidate then you are automaticly entitled to our Swift benefits package, if you want to opt out of this benefits package for whatever reason please tick here