Test Form - FHS24

FRENDY HEALTHCARE SERVICES APPLICATION PACK

Dear Applicant,

Thank you for selecting FHS²⁴. Our team is committed to ensuring that your work requirements are met whenever possible. We specialise in providing high-quality locum Nurses and HCA’s to a wide range of Private and Charitable healthcare providers.

FHS²⁴ success depends on how well we work together. To achieve this there have to be agreed rules, guidelines and standards of conduct for all; these are fully explained in the Staff Handbook in conjunction with our Policies and Procedures. Copies of these are available on request and shortly via our website www.fhs24.co.uk.

The amount of work that we receive depends not only on us, but also on your performance, therefore we have some basic expectations of you, which are listed in your terms of engagement. These include:

• Making sure you arrive on time for your placement, or preferably 5 minutes early. If you are running late, you must ring the office or out of hours mobile as soon as possible and advise us of this so that we can let the client know.

• You represent FHS²⁴ at the client, so please ensure that you perform your expected duties professionally and willingly at all times.

• If you cannot make your shift, you must give adequate notice in order for you to be replaced.

• FHS²⁴will only pay on receipt of an authorised timesheet. Weekly payments are made provided the timesheet arrives by Tuesday 12.00pm for payment on Friday. Please check with your consultant that your timesheet has been received. Payment is made 1 week in arrears.

If for any reason you’re unhappy with any aspect of the service that FHS²⁴ provides, please feel free to contact our Office Team on 01935 388586.

Please take some time before starting your first placement with us to familiarise yourself with your Terms and Conditions of Employment. This information should provide you with all of the reference material you may require, but please feel free to ask your FHS²⁴ consultant if there is anything that you are unsure of, as we are always here to help.

Thank you and welcome to FHS²⁴.

Yours sincerely,

Section A - Personal Information

Personal Details

Title *

Surname *

First Name *

Previous Name(if applicable)

Street Address *0 / 65

Town *

ZIP / Postal Code

Country

Job Choice *What job are you applying for?

Passport Details *What is your visa status?

Specify others...

Contact Information

Please double check that your contact details are correct

Mobile Number *

Email Address *(Please make sure you have access to the email provided)

Next Kin Information

Title *

Surname *

First Name *

Relationship *(who is this person to you?)

Street Address *0 / 65

Town *

ZIP / Postal Code

Country

Mobile Number *

Email Address

First Contact

How did you first get to hear about FHS24? *AdvertReferred byWebsiteOthers...

Name of Referral *0 / 48

Specify others...0 / 48

Section B - Qualification and Training

Nursing Details (Optional)

NMC/HPC Registration No

Expiry Date

Part(s) of Register

Education Details

Please send copies of diploma/degree and other relevant certificates. Original to be presented at interview!

Name of University/College0 / 54

Qualification

Date Qualified

Date Started

Specify Others0 / 54

Training Providers and Expiration Date

Do you have any of the training listed below? If "Yes", provide details with expiry date. If "No", go to next page. It is a mandatory requirement that the following training is updated annually.

Have you had any previous Training?YesNo

Training provider for Emergency First Aid0 / 27

Expiry Date

Training provider for Moving & Handling0 / 27

Expiry Date

Training provider for Fire Safety Training0 / 27

Expiry Date

Training provider for Health & Safety0 / 27

Expiry Date

Training provider for Infection Control0 / 27

Expiry Date

Training provider for Deprivation of Liberty (DOLS)0 / 27

Expiry Date

Training provider for Confidentiality0 / 27

Expiry Date

Training provider for COSHH0 / 27

Expiry Date

Training provider for Equality and Diversity0 / 27

Expiry Date

Training provider for Safeguarding of Vulnerable Adults0 / 27

Expiry Date

Training provider for Food Hygiene0 / 27

Expiry Date

Training provider for Medication Training0 / 27

Expiry Date

Training provider for Person Centred Care0 / 27

Expiry Date

Training provider for Challenging Behaviour0 / 27

Expiry Date

Training provider for Epilepsy0 / 27

Expiry Date

Section C - Employment Section

Provide your most recent employment history first.

Employment (1)

Employer's Name

Start Date

(date you started work here)

End Date

(date you ended work here)

Address *0 / 65

Position and Reason for Leaving0 / 80

Add More Employment History? (+)YesNo

Employment (2)

Employer's Name

Start Date

(date you started work here)

End Date

(date you ended work here)

Address *0 / 65

Position and Reason for Leaving0 / 80

Add Third Employment History? (+)YesNo

Employment (3)

Employer's Name

Start Date

(date you started work here)

End Date

(date you ended work here)

Address *0 / 65

Position and Reason for Leaving0 / 66

Section D - Reference Section

Current Employer (Please provide "Current Employer" details and any of the other 2 below)

Company Name

Name

Position

Address *0 / 65

ZIP / Postal Code

Phone

Email

Previous Employer

Company Name

Name

Position

Address *0 / 65

ZIP / Postal Code

Phone

Email

3rd Employer (Can be a character referee)

Company Name

Name

Position

Address *0 / 65

ZIP / Postal Code

Phone

Email

Working Time Regulations

The Working Time Regulations 1998 require employers to limit the number of hours worked by any employee to 48 hours per week, unless an employee agrees to work outside of that limit.

FHS²⁴ wish to have an agreement with candidates which includes: -

The Working Time Regulations (48 hours working week) will not apply to candidates
Candidates may terminate the agreements by providing FHS²⁴ with 4 weeks of written notice

Under the regulations, FHS²⁴ will keep records relating to candidates working time and will do so regardless of candidates’ acceptance of the proposed agreement above.

Section E - Disclosure of Criminal Background

Confidential

Title

First Name

Middle Name

Last Name

Gender

Date of Birth

Place of Birth

Street Address *0 / 65

City

State/Province

ZIP / Postal Code

Country

Do you have a Previous Name?YesNo

Date of Name Change

Previous Names

NOTE: It is a statutory requirement for any employee to make a full disclosure of any criminal record, however trivial it may seem.

Prior to commencement of employment you will be required to complete an enhanced Disclosure and Barring Service (DBS) form, formally known as a Criminal Records Bureau check which FHS24 will arrange. On receipt of this, any declaration of criminal record – self declared or reported by the DBS – is likely to be discussed in confidence by a representative of the Company, a satisfactory outcome of any such discussions is essential.
The requirement to declare any criminal record is mandatory, making a false or inaccurate statement will be treated as misconduct and/or an act of dishonesty. Applicants who fail to make a declaration will not be offered a place

Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?YesNo

Please look at the following links below if you require further information:

- DBS filtering guidance
- Rehabilitation of offenders

Section F - Vaccination History Section

We require the following:

1. Have you done Covid-19 vaccination?Proof that you have done your coronavirus vaccination.

Type

Date

2. Have you done Tuberculosis vaccination?A certificate from your doctors’ surgery or occupational health department of a positive BCG scar or record of a positive skin test.

Date

3. Have you done Mumps, Measles and Rubella vaccination?A certificate of vaccination or blood test result showing your immunity levels.

Date

4. Have you done Varicella vaccination?A certificate of vaccination or blood test result showing your immunity levels.

Date

5. Have you done Hepatitis B vaccination?You must provide a copy of the most recent pathology report showing titre levels of 100lu/l or above, or antigen status if titre level is below 100lu/l.

Date

6. Have you done Hepatitis B Surface Antigen vaccination?Hepatitis B Surface Antigen Proof of a negative result

Date

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