I also confirm I have read and understood the iCare24 OPT-OUT OF 48 HOUR WORKING WEEK AGREEMENT limit shall not apply to my assignments in accordance with paragraph 3 of the agreement. I understand that under paragraph 4, WITHDRAWAL OF CONSENT, I can end this agreement by giving 14 days notice in writing. We protect people's privacy.
If you are interested in joining a limited/ umbrella company please tick this box and We will have a representative call you with more information about this service:
If you require to be paid through a UK Limited or Composite company, then the following details are required. N.B. Please leave blank if you wish to be paid under PAYE.
REHABILITATION OF OFFENDERS ACT: Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4.2 of the Rehabilitation of Offenders Act 1974 (Exemption Order 1975). Applicants are therefore, not entitled to withhold information about convictions which for other purposes are spent under the provisions of the Act and in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to an application for positions in which the Order applies and should be entered at the end of any particulars you give in support of your application. A copy of our written policies is available upon request. A criminal record will not necessarily be a bar to obtaining a position. You may be offered an opportunity to work within an Environment or establishment where you come into contact with children or other vulnerable groups, or your professional occupation may fall within certain expected categories where this is likely to apply, the Rehabilitation of Offenders Act 1974 (exceptions) order 1975 requires us to ask you for additional information. A criminal check from the Criminal Records Bureau may be required when this type of work is sought. Please answer all of the following questions. If you answer yes to any of the questions, PLEASE PROVIDE FULL WRITTEN DETAILS. Any other information that may have a bearing on your suitability for the position for which you are applying should also be attached. Please note: You do not need to tell us about parking offences.
Please note: you must inform us immediately if you are charged with any offence in the United Kingdom or in any other country after you complete this form and before taking up any position offered to you.
(Investigatory bodies include Local Authorities, Customs and Excise, Immigration, Passport Agency, Inland Revenue, Work and Pensions, Security Agencies, Financial Service Authority, Banks & Building Societies: this list is not exhaustive, and you must declare any investigation conducted by an Investigatory Body).
Please give details on continuous employment history during the last 10 years, most recent first.
Please tick any certificates that you hold
Please tick the appropriate experience:
I declare that the information given in this application form is true and complete to the best of my knowledge and belief. I have read and understood the Terms of Engagement booklet given to me. I agree to comply with the current Health & Safety at Work Act. I understand that my appointment is subject to the receipt of a minimum of two satisfactory references and is subject to Disclosure. I authorise iCare24 to make any other enquiries they may feel necessary to support my application. I agree to respect the confidentiality of patients and clients and any other information I may have access to at all times. I understand that I can access the policies and procedures and staff handbook via the Internet www.icare24.co.uk PAPER BASED COPIES ARE AVAILABLE ON REQUEST.
All candidates registering with iCare24 must have a pre-appointment health check. Pre-appointment health checks are carried out to: ensure that prospective agency workers are physically and psychologically capable of doing the work proposed, taking into account any current or previous illness, identify anyone likely to be at excess risk of developing work-related diseases from hazardous agents present in the workplace and ensure, as far as possible, that prospective agency workers do not represent a risk to patients and that they will be doing work that is suitable and safe for them.
I declare that the information in this form is true and complete to the best of my knowledge. I agree that any deliberate omission, falsification or misrepresentation in application for registration may be grounds for rejecting my application or subsequent removal from iCare24 active Register of Workers. I hereby agree to inform iCare24 of any changes in my health circumstances that may affect my ability to work.
I acknowledge that my personal details will be stored and handled by the Occupational health provider of choice in accordance with the Data Protection Act 1998. I agree that they may be made available for audit or othe-r legitimate purposes to NHS Bodies and Hospitals
Your answers to this questionnaire will be CONFIDENTIAL to Occupational Health and will not be given to anyone else without your written permission. The purpose of the questionnaire is to see whether you have any health problems that could affect your ability to undertake the duties of the post you wish to register for or place you at any risk in the workplace. Occupational Health may recommend adjustments or assistance as a result of this assessment to enable you to do the job. Please help us to help you by completing the questionnaire as fully as possible.
Please answer ALL of the following questions. Please note that leaving a question blank may delay your health clearance:
Dates of immunisations and blood tests Please provide the following details of your immunisation record and enclose your most recent certificates or laboratory reports: Please email any records or certificates seperatley to firstname.lastname@example.org
If yes, do you have evidence of a BCG scar? (Please note this needs to be viewed and documented by a UK Occupational Health department in your health screening)
If yes you cannot perform EPP until you have supplied suitable test certificates from a UK Occupational Health Department for HIV, Hepatitis C and Hepatitis B (if you do not have the required documentation we will be able to perform the relevant test for you). These are mandatory for any EPP post. Results must be less than six months old and indicate that it was an identity validated sample (IVS) on the serology report>
If yes you must supply suitable identity validated test certificates from a UK Occupational Health Department before you can start for Hepatitis B. Results must be less than six months old and indicate that it was an identity validated sample (IVS) on the serology report.
Do you have any of the following:
I give permission for a member of the Occupational Health team to communicate with my own general practitioner, or any other health professional, if further information is required and for that GP or healthcare professional to give details of my clinical condition or other relevant information to the OH advisor/physician. I understand that I shall be contacted to obtain my fully informed consent before any report is requested and that under the Access to Medical Reports Act, 1988: I have the right to see the report before it is sent. I am entitled to ask the doctor to amend or modify information which I consider is inaccurate. I have 21 days from notification to seek access to the report.
I understand that if any recommendations to my employer are necessary as a result of a Work Health Assessment, Occupational Health will discuss the recommendations with me before making them to iCare24.
By Completing this form, you agree to join our Group of Agencies. These consist of iCare24 Limited, Vitality24 Limited, and Raven Medical Staffing Ltd & Ixxos Search Ltd.
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