Candidate Registration Form

Health

I am not aware of any condition, medical or otherwise, which would limit or affect my employment or performance. The information contained within this application is, to the best of my knowledge, a true and complete account, including but not limited to my professional history, criminal convictions, and my medical records. In addition, I permit HeartStone Care to have access to my medical records pertinent to my immunisation and blood test history.

Terms & Conditions

I confirm that the information given in this application is to the best of my knowledge. I am permitted to work in the UK. I understand that my registration is subject to the receipt of at least two satisfactory references and enhanced disclosure from the Disclosures and Barring Service. I understand to inform HeartStone Care should I be convicted of an offence in the future. I agree to respect the confidentiality of patient and any other information I may have access to, at all times.

 

I have read, retained a copy of, and fully understand the attached "Rules for members working in hospitals". I am clear that HeartStone Care work on a temporary assignment and cannot guarantee any number of hours, they have no responsibility to pay for hours not worked, regardless of the situation. I have read, understood, and agree to the terms & conditions of work for temporary agency workers, of which I have been given a copy.

 

I duly authorize HeartStone Care or any nominated third parties to verify the information that I have provided, as required and in the common interests of patient safety. In addition, I agree that HeartStone Care may forward to authorised recipients, and in strictest confidence, confidential details held on my file in relation to my registration, employment, and/or Occupational Health Status.

Induction / Interview

I acknowledge that I have been given HeartStone Care Terms and Conditions and confirm I will abide by the contents of the document.

GDPR Consent and Data Protection

 

I hereby give my consent to HeartStone Care to process the following information – Personal data (name, date of birth, contact details, telephone number, email address, postal address, experience, training, qualifications, CV, national insurance number, gender, nationality, next of kin), Sensitive personal data (disability/health condition relevant to the role, occupational health, criminal conviction).

 

I consent to HeartStone Care to process the above personal data for the following purposes: to provide me with work-finding services, to process or transfer my personal data to their client, on a computerised database in order to provide me with work-finding services, to process my data using automated decision-making processes, to process my personal data with third parties including for the purposes of internal/external audits, investigations and complaints carried out on HeartStone Care to ensure that the company is complying with all laws and regulations.

Agency Worker Confidentiality Agreement

I agree that any information given or obtained by me in the course of any placement will be kept in the strictest confidence and in a safe and secure place. I acknowledge no information is to be removed from client premises without the permission of the Client. Any information used will be for the purpose of work and will not be disclosed to third parties or copied except as required in the course of my duties.

 

I agree that any breach of this undertaking by me or any third party to whom I release the information to may result in legal action proceedings being commenced against me including a claim for the recovery of any losses or damages incurred by the Client as a result of that breach.

Your Work Health Assessment Guidance

The Work Health Assessment requirements as laid down by the Department of Health is that members must complete a health questionnaire to ensure that they are fit to carry out the duties required. For new starter members at HeartStone Care, you are required to conduct an Occupational Health pre-employment screening prior to your first placement. This must be updated on an annual basis.

Deductions

As per the terms and conditions of our agreement, please be advised that any expenses that may have been incurred by HeartStone Care on your behalf, including but not limited to the costs associated with obtaining a Disclosure and Barring Service (DBS) check, Protecting Vulnerable Groups (PVG) membership, training, and uniform, shall be deducted from your initial pay. We appreciate your understanding and cooperation in this matter.

Consent

I hereby authorise the disclosure and release of any and all information and documents required for the purpose of registration with HeartStone Care for employment. This includes, but is not limited to, my professional qualifications, employment history, references, and criminal record checks. By signing this form, I consent to HeartStone Care to share my information/documents for employment purposes.

 

I understand that HeartStone Care may need to contact third parties, such as educational institutions and employers, to verify the accuracy of the information provided. I also understand that the healthcare agency may share my information with other organizations, such as law enforcement agencies or healthcare regulatory bodies, where necessary.

 

I confirm that I have obtained the necessary consent from any professional contacts or referees I have listed on my application for them to share information about me with HeartStone Care.

 

I understand that any information provided to HeartStone Care will be handled in accordance with data protection legislation and regulations, and that my personal information will be kept confidential and secure. I declare that the information I have provided in my application for registration is true, accurate and complete to the best of my knowledge and belief.

 

I confirm that I have read and understood the Terms of Business and the Key Information Document (KID), which have been provided to me along with the registration form. I understand that these documents outline the responsibilities and obligations of both HeartStone Care and myself in relation to the registration process.