Healthcare Worker Registration (Online) V3

Healthcare Worker Online Registration

THE ANTICIPATED DURATION FOR COMPLETING THIS FORM IS 30 MINS

This will depend on you having all requirements ready before you get started


Welcome to Seek Staffing Ltd Healthcare Worker online registration form! We are thrilled to have you here and appreciate your interest in becoming a part of our dynamic team of healthcare professionals.

Whether you're an experienced worker looking for flexibility in your schedule or a newly recruited healthcare worker eager to gain valuable experience, our agency is dedicated to helping you achieve your professional goals. We value your commitment to delivering high-quality healthcare services, and we're committed to supporting your career growth and personal development.

Please take a few moments to provide accurate and detailed information, as it will help us better understand your unique skills and preferences. Thank you for choosing our agency to further your nursing career

 

Membership Requirement for Form Submission

To submit this form, it is a requirement to be a signed up Seek Staffing member. If you are not already a member, you can easily become one by clicking here

Once you have successfully signed up and login as a member, you can return to the form you wish to submit. You will now have the necessary access to complete and submit the form. If you encounter any issues during the membership sign up process or require assistance,  contact our support team at admin@seekstaffing.com  or call 0208 050 2061.

REGISTRATION REQUIREMENTS

All requirements below are a must have before you can be fully registered


To complete your registration with Seek Staffing Ltd, please ensure you provide the following essential documentation and information:

Right to Work: British, Northern Ireland, Wales, and Scotland Citizens should provide a current valid passport. Non-UK citizens should provide current & valid international passport, Biometric Residence Permit (BRP) & Share code and any Home Office correspondence. We also accept a full UK drivers licence.

Proof of National Insurance Number (NI): Submit a copy of you NI document

Proof of Address: We require two recent documents that confirm your current address, with dates within the last three months. Accepted document are : Bank Statement, Utility Bill, Tenancy Agreement and Council Tax      

Enhanced DBS: Evidence of an Enhanced Disclosure and Barring Service (DBS) check.

Proof of Immunization: submit documentation that confirms your immunization status.

Mandatory Training / Other Training Certificates: Include certificates or proof of completion for mandatory training and any additional relevant training or certifications.

References: You should submit 2 Clinical Professional References & 1 Character Refeference

Updated CV: Please submit an updated CV that provides a comprehensive overview of your education and employment history, covering the past 10 years.

Passport-Size Picture: Provide a passport-size picture with a plain background for identification purposes.

Your compliance with these requirements will enable us to expedite the registration process and match you with suitable nursing assignments. Please ensure the accuracy and completeness of the documents and information you provide.

Equal Opportunity Monitoring Form - PR26

The information collected from this section is used for Inclusion monitoring


Seek Staffing Ltd is committed to equality of opportunity and fair treatment in all aspects of employment. We aim to provide a working and learning environment which is free from unfair discrimination and will enable staff to fulfil their personal potential. The Equality Act 2010 protects people from discrimination and promotes equality on the basis of a number of ‘protected characteristics’. We ask for information on your ‘protected characteristics’ in order to help us monitor our performance on equality. In line with Government policy, and in accordance with the provisions of GDPR, the information you provide will be held confidentially and It will help us to comply with the law under the relevant Acts and to ensure that our employment policies and practices are fair and effective.

IMPORTANT -  The information in this section is given on a voluntary basis and the information provided will only be used for the monitoring purpose. Please do not enter any identifying marks on this form, so that your information remains confidential. This information will be stored on a database.

Ethnic Origin

Please indicate your Ethnic Origin


Gender

Please indicate your Gender


Religion or Belief

Please indicate your Religion or Belief


Marital Status / Relationship

Please indicate your Marital Status


As per Equality Act 2010

Please indicate your Disability Status


Under the terms of the Act, a disability is defined as a “physical or mental impairment which has a substantial and long- term effect on a person’s ability to carry out day-to-day activities”.


HEALTHCARE WORKER ONLINE REGISTRATION FORM

Please read and agree to the following statements below


Data Protection Statement

The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Agency to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

*I have read and understood the Data Protection Statement

Equality of Opportunity Statement

The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle
that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion,
marital status, sexual orientation, religion or belief, disability, or offending background.

*I have read and understood the Equality of Opportunity Statement



PERSONAL INFORMATION

Complete your Personal Information


GENERAL INFORMATION

Complete your General Information


Work Preference

Please indicate your work preference


NEXT OF KIN

Please provide contact details of at least one person we can contact incase of emergency


BANK DETAILS

We pay your wages directly into your bank account weekly  



EDUCATION HISTORY

Please complete your education history, use the plus icon to add more


Mandatory & Other Training                                                                      Date Completed           Expiry Date


*Complaints Handling

*Conflict Resolution

*COSHH

*RIDDOR

*Domestic Violence & Recognising Abuse

*Equality, Diversity and Human Rights

*Fire Safety

*First Aid In The Workplace

*Food Hygiene

*General Data Protection Regulations (GDPR)

*Handling Medication & Avoiding Drug Errors – Level 2

*Health, Safety and Welfare

*Infection Prevention and Control 

*Information Governance, including Cyber Security

*Learning Disabilities Awareness

*Lone Worker

*Management of Anaphylaxis

*Medication Management (Social Care Workers)

*Moving and Handling 

*Safeguarding Children (SOCA)

*Safeguarding Vulnerable Adults (SOVA)

*Mental Health Act 2007

*Dementia Awareness

*Duty of Care in Health and Social Care

*Autism Awareness

 

*Fluids And Nutrition Awareness

 

This list is not exhaustive of all mandatory training requirements. Kindly include certification for all completed training, even if not listed above.

You can find a list of Mandatory Training we offer at Seek Staffing Ltd here

Your Clinical Experience

Please tick all areas of experience to indicate areas you have expertise in 


Areas of Expertise
A&E
Community
HDU
ITU
Mental Health
Domiciliary
Cardiac
General Wards
Learning Disabilities
Oncology
Orthopaedics
Nurse Home
Clinics
Elderly Care
Nursing Homes
Homeless
Refugee


EMPLOYMENT HISTORY

Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. Click on the Add employment button to add more employment history.

 

Click on the + icon to add more Employment History


Employment Gap

Do you have any gap in your employment History?

Additional Infomation

*Have you ever been termination from a job, undergone disciplinary procedures, or are you currently in a pending hearing/investigation process?

*Could you verify whether you grant permission for the agency to reach out to your former employers?

REFERENCES

Please supply details of 2 clinical and 1 character references


Please provide names, addresses and telephone numbers for referees below whom we may approach for a reference. In line with CQC requirements, we require references (or other satisfactory evidence as the employer may determine) from all previous employers concerned with the provision of services relating to health or social care, or children or vulnerable adults which should include details of why their employment came to an end (note that this is not time limited).

Please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

CLINICAL REFERENCES 1

Provide details of your first referee


CLINICAL REFERENCE 2

Provide details of your second referee


CHARACTER REFERENCE

Provide details of your Character referee


Supporting Document Upload

Please upload all supporting documents. If you have more than 20 documents to upload then add all documents to a zip folder before uploading 



MEDICAL HISTORY

Please give details of your medical history


Clinical Medical Questionnaire - Confidential

 

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 have been offered or place you at any risk in the workplace. We may recommend adjustments or assistance as a result of this assessment to enable you to do the job. Our aim is to promote and maintain the health of all people at work.

Before health clearance is given for employment you may be contacted by Healthier Business UK Ltd and may need to be seen by an occupational health advisor or physician. Your record will be held on file for a short period of time and may be subject to audit. Your file may also be used to cross reference and ascertain your fitness should you register with other clients of Healthier Business UK Ltd.

Candidate (HCA)

Complete your personal details


*GP Details

Complete your GP details below


General Health

Please answer these questions about your general health


*Do you have any illness, impairment, or disability that may impact your work?

*Have you experienced any work-related illness, impairment, or disability?

*Are you currently undergoing treatment or awaiting medical investigations?

*Do you think you may need any adjustments to help you to do the job?

Tuberculosis

*Clinical diagnosis and management of tuberculosis, and measures for its prevention and control (NICE 2006)


Have you lived continuously in the UK for the last year?

*Have you had a cough which has lasted for more than 3 weeks? 

*Have You experienced any unexplained weight loss? 

*Have you experienced any unexplained Fever? 

*Have you had tuberculosis (TB) or been in recent contact with open TB?

Chicken Pox or Shingles

*Answer the below question regarding chiken pox / Shingles


Have you ever had Chicken Pox or Shingles

Immunisation History

*Answer the following questions  question regarding your immunisation history


Have you had triple vaccination as a child (Diphtheria/Tetanus/Whooping COUGH?  

Have you had a BCG vaccination in relation to Tuberculosis?

Have you had triple vaccination as a child (Diphtheria/Tetanus/Whooping COUGH?  

Have you had Polio Vaccination?  

Have you had Tetanus Vaccination?

Have you had Hepatitis B?  

Proof of Immunity

You must provide proof of the following below to be fully registered & compliant 


Varicella: You must provide a written statement to confirm that you have had chicken pox or shingles however we strongly advise that you provide serology test result showing varicella immunity

Tuberculosis: We require an occupational health/GP certificate of a positive scar or a record of a positive skin test result (Do not Self Declare)

Hepatitis B: We require an occupational health/GP certificate of a positive scar or a record of a positive skin test result (Do not Self Declare)

Rubella, Measles & Mumps: Certificate of “two” MMR vaccinations or proof of a positive antibody for Rubella and Measles

EPP Candidates Only

Only EPP candidates should provide proof


Hepatitis B Surface Antigen:  vidence of a negative Surface Antigen Test Report must be an identified validated sample. (IVS)

Hepatitis C:  Evidence of a negative antibody test. Report must be an identified validated sample. (IVS)

HIV:  Evidence of a negative antibody test. Report must be an identified validated sample. (IVS)

Will your role involve Exposure Prone Procedures (EPP)?

Individuals cleared for non-exposure prone procedures must not perform exposure-prone procedures until re-evaluated by Occupational Health. Report needle stick injuries or exposure to Blood-Borne Viruses promptly.

Declaration

Read the declaration below and sign


I will inform my employer if I am planning to or leave the UK for longer than a three month period to enable a reassessment of my health to be conducted on my return. I declare that the answers to the above questions are true and complete to the best of my knowledge and belief. I also give consent for the Healthier Business UK Ltd to make recommendations to my employer.

*Use your mouse or finger on a touch screen to sign above

Criminal records disclosures – our policy

Please read and be informed of our Criminal Records Disclosure Policy


As an organisation assessing applicants’ suitability for positions which are included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order using criminal record checks processed through the Disclosure and Barring Service (DBS), we comply fully with the Code of Practice and undertake to treat all applicants for positions fairly. We will not discriminate unfairly against any subject of a criminal record check on the basis of a conviction or other information revealed. We can only ask an individual to provide details of convictions and cautions that we are legally entitled to know about. Where a DBS certificate at either standard or enhanced level can legally be requested (where the position is one that is included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended) and where appropriate Police Act Regulations (as amended), we can only ask an individual about convictions and cautions that are not protected.

*I have read and I am now informed of Seek Staffing Ltd Criminal Records Disclosure Policy

Privacy Statement

Please read and be informed of our Privacy Statement


We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to us holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you).

When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact the Registered Manager to discuss

*I have read and I am now informed of Seek Staffing Ltd Privacy Statement

Safeguarding / Ex-Offenders Declaration

Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest confidence


The Rehabilitation of Offenders Act 1974 aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Seek Staffing ltd undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.

Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.

*Do you currently have any unspent convictions from a UK or international court, or are you currently bound over?

*Do you currently have any unspent police cautions, reprimands, or final warnings in the UK or elsewhere?

*Do you consent to us obtaining and retaining an enhanced criminal records disclosure throughout your employment or until a new disclosure is completed?

Attention: A valid DBS (Disclosure and Barring Service) is a crucial requirement for the completion of your registration. Without a valid DBS, your registration cannot be finalized
 
 


Declaration

Kindly read, agree & date the following declarations and proceed to provide your signature and today's date below


*Compliance

I understand that I am responsible for ensuring that my personal compliance such as my DBS update service and NHS mandatory annual training are kept up to date. If any of these lapses I will be unable to work until I am fully compliant again


Terms & Conditions

 I confirm that the informa*tion given in this application is true I am permitted to work in the UK I understand that my registration is subject to at least two satisfactory references covering three years and enhanced disclosure from the Disclosure and Baring service


*Working Time Regulations 

For the purpose of the Working Time Regulations 1998 (as amended), I consent to work in excess of an average of 48 hours per week. I understand that I may withdraw this consent by giving Seek Staffing Ltd not less than three months’ notice. I understand that my registration with any company within the Seek Staffing Ltd can be terminated at any time following unsatisfactory work reports or complaints


Bank Details 

*I confirm that the bank details on this form are complete and correct and that any incorrect or incomplete details can result in a delay of any payments.


*Disclosure and Barring Update Service Checks 

I agree that Seek Staffing Ltd can access the DBS update service portal to check for any changes to my DBS clearances as and when necessary 


*Employment History (Referencing)

I agree that Seek Staffing Ltd can contact my present and past employers to obtain reference before my first shift


*Data Protection & Permissions 

I agree that Seek Staffing Ltd retains the right to hold this application and any other data required to process it and to pass on to any authorised third party for the purposes of audit and work placements. I agree that Seek Staffing Ltd can retain these details for as long as reasonably necessary in accordance with the Data Protection Act


*The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent that can seek clarification regarding professional registration details.

Use your mouse or finger on a touch screen to sign above


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