• BSW Hospitals Group Bank Trust Leaver Application Form

  • Thank you for choosing to join bank upon the end of your substantive contract. Please find the following steps to update your profile with us. Upon completion we will be in contact for any further information that maybe required. Please note to be eligible for registration you must be available to work via the bank in the next 3 months.

    As part of your registration, you will need to provide the following documents. Having these ready before you begin will help speed up your application:

    • Proof of your right to work in the UK (passport or visa)

    • A completed application form, including your employment history. We can accept an up-to-date CV to support this

    • Your professional registration details (GMC, NMC, HCPC, GDC, GPC or relevant body)

    • A valid DBS certificate issued within the last 3 years, registered with the update service (enhanced with child and adult workforce for clinical and ancillary roles, standard for non-clinical roles)

    • Two proofs of address dated within the last 3 months (for example, a bank or credit card statement, utility bill or current council tax statement). Please note we cannot accept mobile phone bills or printed online bank statements.

    • Occupational health questionnaire, which will be sent to you separately via Healthier Business

    • Core skills training records or certificates. If you do not have these, we can support you through our training portal

    Please complete each section carefully to avoid any delays to your registration.

    • Personal Details 
    • Sex*
    • Date of Birth*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Format: (+44) 00000000000.
    •  -

    • Please Enter your Next of Kin Details below

    • Format: (+44) 00000000000.
    • Do you hold a British or Irish citizenship?*
    • If not, do you hold any of the following?*

    • This can be generated here: https://www.gov.uk/prove-right-to-work/get-a-share-code-online 

    • Expiry Date
       - -
      2 digit day, 2 digit month, 4 digit year
    • Do you have a professional indemnity insurance?*

    • Bank Partners strongly advises you to have your own Professional Indemnity insurance. Evidence of this Insurance will be required before submission.

    • Work Requirements 
    • Which Trust(s) do you currently work at?*
    • Please confirm your last working day as a substantive member of the trust*
       - -
      2 digit month, 2 digit day, 4 digit year
    • What Staff Group are you a member of?*
    • Please confirm your Professional Body*
    • Expiry Date
       - -
      2 digit day, 2 digit month, 4 digit year
    • What is your availability to work?*
    • When are you available from?
       - -
      2 digit day, 2 digit month, 4 digit year
    • When are you available until?
       - -
      2 digit day, 2 digit month, 4 digit year
    • Professional Qualifications & Training 
    • List your qualifications
    • Do you hold current core skills training certification?*

    • Note that if you do not hold current certification, Bank Partners will be able to provide you with the required training. If yes, we will request evidence of this training to be uploaded prior to the submission of this form.

    • Employment History and References 

    • Line Manager Details

    • Please supply contact details for your most recent line manager at the trust you have left so that we can obtain confirmation for you to remain on the bank. We only require one person’s details. Please note the line manager you have selected must approve your application to join the bank to allow us to process your applicaiton.

    • Start Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • End Date*
       - -
      2 digit month, 2 digit day, 4 digit year

    • Employment History

    • Have you entered new employment since leaving your substantive position?*
    • Do you have an up to date CV you can upload to this form?*

    • You will be required to upload proof of this on the submission page if you click 'Yes'.

    • Please provide us with your employment history using the form below from age 18 to present. You can upload a CV by selecting yes to the above question.

    • Employment History*

    • Reference Details

    • We will be required to obtain a reference from your current place of employment please supply Professional Referee from your most recent employer. Bank Partners can only accept references from your line manager or someone working in a more senior capacity. At least two must be relevant to the specialty or role you are applying for. This may include another Recruitment Agency if you have been undertaking temporary positions but please also provide the details someone within one of your placements that can comment on your clinical ability if applicable to your role.

    • Referees*
    • Revalidations and Appraisals 

    • Appraisals

      Bank Partners will require you to be appraised at least annually by a senior practitioner of the same discipline who is entered on the NMC/HCPC.

      The appraiser must be appropriately trained to complete an appraisal. The appraisal should be completed inline with the Approved NHS Appraisal System, which includes 360 Feedback (NHS Work).

      You should maintain a written portfolio of your professional experience and attendance at professional development courses, which should also include a written and agreed Personal Development Plan as agreed at your appraisals.

    • Date of most recent appraisal
       - -
      2 digit day, 2 digit month, 4 digit year
    •  -

    • Revalidation for Nurses

    • Date of Revalidation
       - -
      2 digit day, 2 digit month, 4 digit year
    • Data Protection and Criminal Records Declaration 

    • Data Protection

    • Bank Partners are processing your data on behalf of Moorfields Eye Hospital NHS Foundation Trust. You confirm that by submitting your personal data that you have read and understood Moorfields Eye Hospital NHS Foundation Trust's privacy notice. 

      We’ll occasionally send you information about our exclusive promotions. We’d hate for you to miss out, but if you’d rather not receive this information, you can opt-out by emailing: dpo@acaciumgroup.com

      You can find more information about managing your marketing preferences here:

      Please note that job opportunities, legal and service updates relating to you working with us are not direct marketing and cannot not be opted out of.

    • Criminal Records

    • Please note that under new filtering rules - certain offenses may be removed from your criminal record after 11 years (5.5 years if you were under the age of 18) Cautions will be removed after 6 years (2 years if you were under the age of 18); providing that this was your only offence and did not result in a custodial sentence. Serious offences will never be filtered. If you are unsure of whether your conviction, caution, or reprimand is filtered, please see the DBS website for more information before signing the declaration. If you do not declare a conviction/caution/reprimand that later appears on your DBS this could result in dismissal or non-employment.

    • Do you have any convictions, cautions or reprimands that are not "protected" as defined by the Rehabilitations of Offenders Act (amended 2013)?*
    • Are you aware of any Police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post?*
    • Have you ever had a police check in another country?*
    • Do you have an up to date DBS or are able to obtain this?*

    • Note that if you answer 'No', Bank Partners will be able to give you guidance on how to obtain a DBS.

      Moorfields will accept a DBS at the correct level that has been completed by an NHS employer within the last three years or a DBS registered with the update service.

      Please also note that if at any stage whilst working for Bank Partners we receive a DBS Enhanced Disclosure that highlights information you have not declared, then you will be removed from your assignment.

    • Declarations

    • Have you ever been subject to disciplinary action or are currently being investigated due to alleged misconduct?*

    • 1. I understand that if I am charged or cautioned after signing this declaration, I must inform Bank Partners.

      2. I have answered questions regarding disciplinary action or alleged misconduct truthfully.

      3. I acknowledge that I will be given a copy of the Terms and Conditions of Service issued by Bank Partners, on behalf of BSW Hospitals Group Bank, at the end of the registration process, which is mine to keep and to abide by.

      4. I am not aware of any condition, medical or otherwise, which would affect or limit my employment or performance, other than those declared in my Occupational Health Questionnaire.

      5. I declare that the information given herein is true and complete and is not presented in a way intended to mislead. I agree that if I have given false or misleading information or omit to give relevant information now or in the future, that Bank Partners may cease to offer me further agency placements without notice, as well as a claim for recovery of any payments I have received, together with a claim for a loss of profit to Bank Partners.

      6. I acknowledge and confirm that Bank Partners is authorised to apply for and obtain a Disclosure and Barring Service Check (including the online status update service check if app) and references from any previous employers and educational establishments.

      7. I acknowledge that my personal details will be stored and handled correctly by Bank Partners in accordance with the Data Protection Act 2018 however, I agree that they may be made available for audit/review by relevant parties. (This is relevant for all information including all documents – DBS, Occupational Health, References).

      8. I understand that if I am on a student visa, I can only work for 20 hours per week during term time. I understand that I have a responsibility to monitor this. In addition, if my position as a student changes, I must inform Bank Partners

      9. I understand that if I am on a Tier 2 Sponsorship Visa, I can only work for a maximum of 20 hours per week at the same professional level as my sponsorship. I understand that I have a responsibility to monitor this. In addition, if my position with my sponsored company changes, I must inform Bank Partners.

      10. I acknowledge that if any of my details stated on this Application Form change, or my circumstances change, which may affect my ability to work for, I must inform Bank Partners immediately.

      11. I confirm that I am not currently under investigation, or currently suspended, by my professional regulatory body (e.g. NMC/HCPC) or being investigated by my current or previous employer. I will inform Bank Partners if I am under investigation or suspended by my professional regulatory body or employer at any point whilst working for Bank Partners.

      12. I give my permission for Bank Partners to run a Right to Work check with the Home Office if I provide them a Biometric Residence Card for my Right to work in the UK.

    • Date*
       - -
      2 digit day, 2 digit month, 4 digit year
    • HMRC Starter Checklist 
    • Employee statement - You need to select only one of the following statements A, B or C*
    • Do you have one of the Student Loan Plans described below which is not fully repaid?

    • For further guidance about repaying Student Loans go to https://www.gov.uk/repaying-your-student-loan

    • Did you complete or leave your studies before the last 6 April?
    • Are you repaying your Student Loan direct to the Student Loans Company by direct debit?
    • What type of Student Loan do you have?

    • Student Loan Plans

      You’ll have a Plan 1 Student Loan if:
      • you lived in Scotland or Northern Ireland when you started your course (undergraduate or postgraduate)
      • you lived in England or Wales and started your undergraduate course before 1 September 2012

      You’ll have a Plan 2 Student Loan if:
      • you lived in England or Wales and started your undergraduate course on or after 1 September 2012
      • your loan is a Part Time Maintenance Loan
      • your loan is an Advanced Learner Loan
      • your loan is a Postgraduate Healthcare Loan

    • Date*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Model Declaration 

    • Guidance for applicants – in confidence

      The position you have applied for is identified as exempt under the Exceptions Order of the Rehabilitation of Offenders Act 1974 (as amended in England and Wales).

      This means that when considering any such appointment, the employing organisation is legally permitted to request a standard or enhanced disclosure through the Disclosure and Barring Service (known as a DBS check).

      Standard and enhanced disclosures will include information about all SPENT (old) and UNSPENT (current)convictions, cautions, reprimands and final warnings that are not protected (i.e. are not filtered out) as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013.

      Enhanced disclosures may also include other relevant police information where this is deemed relevant to the position you are applying for.

      Before you complete this form, it is important to understand which convictions or cautions are now protected(or filtered) under an amendment to the Exceptions Order to the Rehabilitation of Offenders Act (as amended in England and Wales] which came into force from 29 May 2013.

      Protected convictions and cautions will never be included in a standard or enhanced DBS disclosure. Applicants are not legally required to declare any such convictions or cautions to an employer, and the employing organisation is not entitled to consider any such offences as part of their recruitment process.

      If you have a criminal record and have any queries or concerns about the type of information you may be asked to declare, please refer to the following sources for further guidance.

      https://unlock.org.uk/information-and-advice/ - Unlock
      https://www.nacro.org.uk/about-us/volunteering/ – NACRO
      https://www.gov.uk/government/publications/dbs-filtering-guidance/dbs-filtering-guide – Unlock
      https://www.nacro.org.uk/nacro-services/criminal-record-support/advice-for-employers/ - NACRO

      Our Commitment to you

      Before you can be considered for appointment with Bank Partners we need to be satisfied about your character and suitability.

      If the position has, in addition, been identified as a regulated activity under the Safeguarding Vulnerable Groups Act (2006) (as amended by the Protection of Freedom's Act 2012) an enhanced DBS disclosure will include information which is held on the Children's and/or Adults barred list(s), as applicable to the position.

      Bank Partners aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity, marriage or civil partnership. We undertake not to discriminate unfairly against applicants on the basis of criminal conviction or other such information declared.

      Prior to making a final decision concerning your application, we shall discuss with you any information declared by you that we believe may have a bearing on your suitability for the position.

      If we do not raise this information with you, this is because we do not believe that it should be taken into account. In that event you still remain free, should you wish, to discuss the matter with the recruiting manager. As part of assessing your application, we will only take into account criminal records and other information declared which is relevant to the position being applied for.

      The information that you provide in this declaration form will be processed in accordance with the Data Protection Act 1998. It will be used for the purpose of determining your application for this position. It will also be used for purposes of enquiries in relation to the prevention and detection of fraud.

      Please answer all of the questions within this form.

      If you answer ‘YES’ to any of the questions, please use the space indicated to provide any information that you believe may have a bearing on your suitability for the position for which you are applying.

      Please use the continuation sheet provided in this form to include any additional information or supplementary comments you wish us to consider in support of your application. You may continue on a separate sheet if necessary.

      It is important to stress that answering ‘yes’ to any of the questions below will not necessarily prevent you from taking up an appointment in the NHS. This will depend on the relevance of the information you provide in respect of the nature of the position for which you are applying, and the particular circumstances.

      It is important to stress that answering ‘yes’ to any of the questions below will not necessarily prevent you from taking up an appointment in the NHS. This will depend on the relevance of the information you provide in respect of the nature of the position for which you are applying, and the particular circumstances.

      All cases will be examined on a case by case basis, and will consider the following.

      If the conviction is relevant to the position applied for.
      The seriousness of the offence.
      The age of the applicant at the time of the offence(s).
      The length of time since the offence(s) occurred.
      If the applicant has a pattern of offending behaviour.
      The circumstances surrounding the offence(s) and the explanation(s) offered by the applicant.
      If the applicant’s circumstances have changed since the offending behaviour.
      It is important to be aware, that the failure to disclose all unspent and unspent convictions which you are legally obliged to declare (i.e. those that are not protected under the DBS filtering rules), could result in disciplinary proceedings or dismissal.

      If you have a criminal record and have any queries or concerns about the type of information you may be asked to declare, please refer to the following sources for further guidance.

      https://unlock.org.uk/information-and-advice/ - Unlock
      https://www.nacro.org.uk/about-us/volunteering/– NACRO

    • 1. Are you currently bound over, or do you have any convictions, cautions, reprimands or final warnings that would not be protected (filtered) as defined by the Exceptions Order 2013 - that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?*

    • If YES, please provide details of the order binding you over and/or the nature of the offence, penalty, sentence or order of the Court, the date and place of the Court hearing.

      It is important for you to understand which convictions or cautions are now protected (or filtered) under an amendment to the Exceptions Order to the Rehabilitation of Offenders Act (as amended in England and Wales) which came into force from 29 May 2013 – see further information in the ‘guidance for applicants’ which accompanied this form.

      You are not required to tell us about parking offences.

      Please include any additional information, or other supplementary comments that you believe to be relevant. 

    • 2. Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?*

    • If YES, please include details of the nature of the offence with which you are charged, date on which you were charged, and details of any on-going proceedings by a prosecuting body.

      You are reminded that, if you are appointed, you have a continued responsibility to inform us immediately where you are charged with any new offence, criminal conviction or fitness to practise proceedings in the United Kingdom or in any other country that might arise in the future, while you are in our employment.

      You are not required to tell us about parking offences.

      Please include any additional information, or other supplementary comments that you believe to be relevant.

    • 3. Are you aware of any current investigations being undertaken by NHS Counter Fraud and Security Management Service (NHS CFSMS) following allegations of made against you?*

    • If YES, please provide details of the nature of the allegations made against you, and if known to you, any action to be taken against you by NHS CFSMS.

      Please include any additional information, or other supplementary comments that you believe to be relevant.

    • 4. Have you been investigated by the Police, the NHS Counter Fraud and Security Management Service (NHS CFSMS), or any other investigatory body resulting in a current or past conviction or dismissal from your employment or volunteering position?

    • If YES, please provide details of the nature of the allegations made against you, and if known to you, any action to be taken against you by the investigatory body.

      Investigatory bodies include: HM Customs and Excise, Inland Revenue, Financial Service Authority, Department of Trade and Industry, Department of Work and Pensions, immigration and border force, security agencies, local authorities etc. This list is not exhaustive and you must declare any investigation conducted by an investigatory body.

      Please include any additional information, or other supplementary comments that you believe to be relevant.

    • 5. Have you ever been dismissed by reason of misconduct from any employment, volunteering, office or other position previously held by you?*

    • If YES, please provide details of the employment, office or position held, the date that you were dismissed and the nature of allegations of misconduct made against you.

      Please include any additional information, or other supplementary comments that you believe to be relevant.

    • 6. Have you ever been removed from the register or have conditions or undertakings been made on your registration by a fitness to practice committee, regulatory or licensing body in the United Kingdom or in any other country?*

    • If YES, please provide details of any conditions or undertakings which have been applied to your professional registration and the name and address of the regulatory or licensing body concerned.

      You are not required to provide details where any right to appeal has been upheld AND where that appeal has resulted in your case being fully exonerated.

      Please include any additional information, or other supplementary comments that you believe to be relevant.

    • 7. Are you currently subject to a fitness to practice investigation and/or proceedings by a regulatory or licensing in the United Kingdom or in any other country?*

    • If YES, please include the reasons given for the investigation and, where applicable, the details of any proceedings, limitations or restrictions that currently apply to your professional registration, and the name and address of the regulatory or licensing body concerned.

      Please include any additional information, or other supplementary comments that you believe to be relevant

    • 8. Are you subject to any other prohibition, limitation, or restriction that means we are unable to consider you for the position for which you are applying?*

    • If YES, please include details.

      Please include any additional information, or other supplementary comments that you believe to be relevant

    • 9. Are there any other matters in your background that may be relevant to the position being applied for, which might cause your reliability or suitability to be called into question?*

    • If YES, please include details.

      It is important for you to understand which convictions or cautions are now protected (or filtered) under an amendment to the Exceptions Order to the Rehabilitation of Offenders Act (as amended in England and Wales) which came into force from 29 May 2013 – see further information in the ‘guidance for applicants’ which accompanied this form.

      Please include any additional information, or other supplementary comments that you believe to be relevant.

    • Declaration

    • IMPORTANT


      The Data Protection Act 1998 requires us to advise you that we will be processing your personal data. Processing includes: holding, obtaining, recording, using, sharing and deleting information. The Act defines ‘sensitive personal data’ as racial or ethnic origin, political opinions, religious or other beliefs,
      trade union membership, physical or mental health, sexual life, criminal offences, criminal convictions, criminal proceedings, disposal or sentence.

      The information that you provide in this declaration form will be processed in accordance with the Data Protection Act 1998. It will be used for the purpose of determining your application for this position. It will also be used for purposes of enquiries in relation to the prevention and detection of fraud. 

      Once a decision has been made concerning your appointment, Bank Partners will not retain this declaration form any longer than is necessary - see further details in the supplementary guidance notes for applicants which we provided with your application form. This declaration will be kept securely and in confidence. Access to this information will be restricted to designated persons within the organisation who are authorised to view it as a necessary part of their work.

      In signing the declaration on this form, you are explicitly consenting for the data you provide to be processed in the manner described above.

       

      I confirm that the information that I have provided in this declaration form is correct and complete. I understand and accept that if I knowingly withhold information, or provide false or misleading information, this may result in my application being rejected, or if I am appointed, in my dismissal, and I may be liable to prosecution.

    • Date*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Upload & Submit 

    • You're almost there! To complete your application, please upload the below documents before submitting. Please note, you can upload more than one document to each section if required.

      Want to do this later? No problem. Click 'Save' on the bottom right corner of this form. You'll receive a link with which you can continue your application at a time most convenient to you. 

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    • Please include all four corners of this document. If you are uploading a Biometric Residence Permit please upload both the front and the back of the document. If you are using a UK Birth Certificate, you will also need to provide a proof of National Insurance. n.b. we are not able to accept payslips. Further verification of these documents maybe required. 

       

      If you hold a Sponsorship visa please ensure you upload a copy of your sponsorship certificate along with evidence in the form of a current play slip or referee/sponsor contact details so we can obtain a letter from your sponsor to confirm you still work for your sponsor in your sponsored role.

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    • DBS

    • You've advised earlier within this form that you require support obtaining a DBS - please follow these instructions:

      • Follow this link to complete your DBS application: https://www.hr-platform.co.uk/individual/application-welcome
      • You will then need to provide information about yourself, address and employment history, as well as additional information including and previous names you have used.


      Once complete, we will use documents you have uploaded to this form to support the new application. Please note once you have applied a payment link for this new DBS will be provided to you for completion. 

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    • These can be bank or credit card statement or utility bill (all must be dated less than 3 months old), a Driving Licence (front and back), or a current Council Tax Statement (current period).

      Please note that we cannot accept mobile phone bills or online printed bank statements

      See here for acceptable proof of address: https://www.gov.uk/government/publications/dbs-identity-checking-guidelines

       

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