Agency Consent Form
As you are joining Bank Partners, we will need to submit an intention to hire notice to your agency for you to transfer over to Bank.
This does not mean you are leaving your agency, you will be able to work agency shifts at other hospitals, just not at the trust you're transferring to. Please could you fill out the below and at your earliest convenience so we can serve the agency notice.
Your Name
*
First Name
Last Name
Your Date of birth
*
/
Day
/
Month
Year
Date
Your Phone Number
*
Please enter a valid phone number.
Your Email
*
example@example.com
Your Current Job Role
*
Your Current Band
*
Your Specialty
*
Trust you're transferring to
*
Please Select
Barking, Havering and Redbridge University Hospitals NHS Trust
Barts Health NHS Trust
GOSH NHS Foundation Trust
Hounslow and Richmond Community Healthcare NHS Trust
Isle of Wight
Kingston NHS Trust
Moorfields NHS Foundation Trust
North Middlesex Hospital NHS Trust
Portsmouth Hospitals University NHS Trust
UCLH NHS Trust
Whittington Health NHS Trust
Please enter details of the Agency you are transferring from so we can provide them with notice
Agency Company Name
*
Agency Consultant Email
*
example@example.com
Agency Consultant Name
*
First Name
Last Name
Please sign below to confirm the accuracy of the above information and to authorise us to contact your Agency to serve notice on your behalf. This also acknowledges your understanding of the agreed pay rates for your transfer.
Signature
*
Submit
Should be Empty: