Do you have any health issues or disabilities that will prevent you from carrying out your duties as a Healthcare Professional to a satisfactory standard?

In view of the nature of the work for which you are applying, this post is exempt from the provision of 2.4(2) of the Rehabilitation of Offender Act 1974 by virtue of the Rehabilitation of Offenders Act (Exceptions) Order 1975. Applicant are, therefore, not entitled to withhold information about convictions, which for other purposes are “spent” under the provision of the Act and, in the event of employment, any failure to disclose such convictions would result in dismissal. Any information given will be completely confidential and will be considered only in relation to this application.

You automatically accept our code of confidentiality when you register with Watergate Healthcare Limited.
 
In the course of your duties you may have access to confidential information about patients / clients. On no account must information relating to identifiable clients be divulged to anyone but your branch managers or his / her assistant.
 
You should not disclose ANY information to your family, friends or neighbors.
If you are worried by any information you have obtained and wish to discuss it, please make an appointment to speak in private to your branch manager.
 
Failure to observe these rules will be regarded as serious misconduct, which could result in your removal from the Watergate Healthcare Ltd register.
 
I have read and understood the Watergate Healthcare Ltd code of confidentiality and agree to abide by its contents.

 
The personal details contained in this application form, and any additional personal information contained in any other documents supplied to us with your application will be retained and processed by WATERGATE HEALTHCARE LIMITED as data controller, and may be passed to necessary authorities and employers as required to enable you to work as an agency worker with us.  In proceeding with your application with us and during and following your employment, you consent to our processing and use of such information.

 
Watergate Healthcare is fully committed to the principle of Equal Opportunities in recruitment irrespective of color, race, sex, marital status, sexual orientation, ethnic origin, nationality, religion, disability or age.

 
By signing this application, I declare that all information given by me is accurate and in no way misleading or false.

Certain jobs carry with them a risk of infection. In such cases we offer the facility of being immunised to prevent the risk of infection. Please provide details below of your immunisation history.

HIV/AIDS
 
The company operates a policy of non-discrimination. In line with company policy, and National Guidelines, ‘HSC 1998/226 – Guidelines on the Management of AIDS/HIV Infected Health Care Workers and Patient Notification’ (updated August 1999), you must inform the Director of Training and Quality if you know or suspect you are HIV positive or have an AIDS defining illness. This information is necessary in order that a Risk Assessment may be undertaken to your safety and that of others.
 
If you know or suspect you are either HIV antibody positive or have AIDS, please tick the appropriate box. This information is absolutely confidential to the Director of Training and Quality.

For use with Terms of Engagement of Temporary Workers
 
1.         DEFINITIONS
 
1.1.        In this Agreement the following definitions apply:-
 
“Assignment”                                      means the period during which the Worker is engaged to render services to the Client;
 
“Client”                                                means the person, firm or corporate body engaging the services of the Worker;
 
“Employment Business”                      Watergate Healthcare Limited
 
“Temporary Worker”                           You the Staff
 
“Working Week”                                means an average of 48 hours each week calculated over a 17-week reference period.
 
1.2.      References to the singular include the plural and references to the masculine include the feminine and
 vice versa.
 
1.3.        The headings contained in this Agreement are for convenience only and do not affect their interpretation.
 
2.        RESTRICTION
 
2.1.     The Working Time Regulations 1998 provide that the Temporary Worker shall not work on an Assignment with the Clientin excess of the Working Week unless he agrees in writing that this limit should not apply.
 
3.        CONSENT
 
3.1.     The Temporary Worker hereby agrees that the Working Week limit shall not apply to the Assignment.
 
4.       WITHDRAWAL OF CONSENT
 
4.1.     The Temporary Worker may end this Agreement by giving the Employment Business 1 weeks’ notice in writing.
 
4.2       For the avoidance of doubt, any notice bringing this Agreement to an end shall not be construed as termination by the Temporary Worker of an Assignment with a Client.
 
4.3     Upon the expiry of the notice period set out in clause 4.1 the Working Week limit shall apply with   immediate effect.
 
5.      THE LAW
 
5.1.     These Terms are governed by the law of England & Wales and are subject to the exclusive jurisdiction of the Court of England & Wales.

I declare that the information on this form is true to the best of my knowledge. Further, I understand that if I should be found to knowingly make a false statement regarding my medical history either in answering the above questions or to the Company’s Director of Quality and Training, or should I conceal any material fact, the Company can terminate my contract without notice.  I agree to this Health Questionnaire being kept in my secure personnel file at my branch, which may be subject to a quality audit from time to time.

 1.              DEFINITIONS
 
1.1            In these Terms of Engagement the following definitions apply:
 
“Assignment”                                       means the period during which the Temporary
                                                            Worker is supplied to render services to the Client.
 
“Client”                                                means the person, firm or corporate body requiring the services of the Temporary Worker together with any subsidiary or associated company as defined by the Companies Act 1985.
 
“Employment Business”                        means Watergate Healthcare Limited
 
“Temporary Worker”                            You The Staff
 
1.2            Unless the context otherwise requires, references to the singular include the plural and references to the masculine include the feminine and vice versa.
 
1.3            The headings contained in these Terms are for convenience only and do not affect the
Interpretation.
 
2.              THE CONTRACT
 
2.1            These Terms constitute a contract for services between the Employment Business and the
Temporary Worker and they govern all Assignments undertaken by the Temporary Worker. However, no contract shall exist between the Employment Business and the Temporary Worker between Assignments.
 
2.2            For the Avoidance of doubt, these Terms shall not give rise to a contract of employment between the Employment Business and the Temporary Worker. The Temporary Worker is engaged as a self-employed worker, although the Employment Business is required to make statutory deductions from his remuneration in accordance with clause 4.1
 
2.3            No variation or alteration of these Terms shall be valid unless approved by the
Employment Business in writing.
 
3.              ASSIGNMENTS
 
3.1            The Employment Business will endeavour to obtain suitable Assignments for the
Temporary Worker to work as a (Job role: as a healthcare worker)
 
3.2            The Temporary Worker acknowledges that the nature of temporary work means that there
May be periods when no suitable work is available and agrees: that suitability shall be determined solely by the Employment Business; and that the Employment Business shall incur no liability to the Temporary Worker should it fail to offer opportunities to work in the category or in any other category.
 
3.3            For the purpose of calculating the average number of weekly hours worked by the
Temporary Worker on an Assignment, the start date for the relevant averaging period under the Working Time Regulations shall be 1st October 1998 or the date on which the Temporary Worker commences the first Assignment, if later.
 
3.4            If during the course of an Assignment or within 6 months after the end of an Assignment the Client wishes to employ the Temporary Worker direct, the Temporary Worker acknowledges that the Employment Business will be entitled either to charge the Client an introduction fee or to agree an extension of the hiring period with the Client at the end of which the Temporary Worker may be employed direct by the Client without further charge to the Client.
 
 
 
 
4.              REMUNERATION
 
4.1            The Employment Business shall pay to the Temporary Worker remuneration calculated at a minimum hourly rate of £10.00 The actual rate will be notified on a per assignment basis, for each hour worked during an Assignment (to the nearest quarter hour) to be paid weekly in arrears, subject to deductions in respect of PAYE pursuant to Section 134 of the Income and Corporation Taxes Act 1988 and Class 1 National Insurance Contributions and any other deductions which the Employment Business may be required by law to make.
 
4.2            Subject to any statutory entitlement under the relevant legislation, the Temporary Worker is not entitled to receive payment from the Employment Business or Clients for time not spent on Assignment, whether in respect of holidays, illness or absence for any other reason unless otherwise agreed.
 
5.              STATUTORY LEAVE
 
5.1            For the purposes of calculating entitlement to paid annual leave pursuant to the Working Time Regulations 1998, the leave year commences on the date that the Temporary Worker starts an Assignment or a series of Assignments.
 
5.2            Under the Working Time Regulations 1998, the Temporary Worker is entitled to 4 weeks’ paid leave per leave year. All entitlement to leave must be taken during the course of the leave year in which it accrues and none may be carried forward to the next year.
 
5.3            Entitlement to payment for leave accrues in proportion to the amount of time worked continuously by the Temporary Worker on Assignment during the leave year. The amount of payment which the Temporary Worker will receive in respect of periods of annual leave taken during the course of an assignment will be calculated in accordance with and paid in proportion to the number of hours which he has worked on Assignment.  
 
5.4            In the course of any assignment during the first leave year the Temporary Worker is entitled to request leave at rate of one-twelfth his total holiday entitlement in each month of his leave year. Where the Temporary Worker wishes to take any leave to which he is entitled, he should notify the amount of notice that the Temporary Worker is required to give should be at least twice the length of the period of leave that he wishes to take. Unless the Employment Business informs the Temporary worker in writing that it is not possible for him to take leave on the specified dates, the Temporary Worker shall be entitled to take up his notified leave entitlement.
 
5.5            Where a Bank holiday or other public holiday falls during an Assignment and the Temporary Worker does not work on that day, the public holiday shall count as part of the Temporary Worker’s paid annual leave entitlement.
 
5.6            None of the provisions of this clause regarding the statutory entitlement to paid leave shall affect the Temporary Worker’s status as a self-employed worker.
 
6.              SICKNESS ABSENCE
 
6.1            The Temporary Worker may be eligible for Statutory Sick Pay provided that he meets the relevant statutory criteria.
6.2            For the purpose of the Statutory Sick Pay scheme there is one qualifying day per week during the course of an assignment and that qualifying day shall be the Wednesday in every week.
 
7.              TIME SHEETS
 
7.1            At the end of each week of an Assignment (or at the end of the Assignment where it is for a period of one week or less or is completed before the end of a week) the Temporary Worker shall deliver to the Employment Business his time sheet duly completed to indicate the number of hours worked by him during the preceding week (or such lesser period) and signed by an authorised representative of the Client. Failure to submit a time sheet for hours worked may delay payment for those hours.
 
 
7.2            For the avoidance of doubt and for the purposes of the Working Time Regulations, the Temporary Worker’s working time shall only consist of those periods during which he is carrying out his activities or duties for the Client as part of the Assignment. Time spent traveling to the Client’s premises, lunch breaks and other rest breaks shall not count as part of the Temporary worker’s working time for these purposes.
 
8.              CONDUCT OF ASSIGNMENTS
 
8.1            The Temporary worker is not obliged to accept any Assignment offered by the Employment Business but if he does so, during every Assignment and afterwards where appropriate, he will:-
 
8.2            Co-operate with the Client’s staff and accept the direction, supervision and control of any responsible person in the client’s organisation;
 
8.3            Observe any relevant rules and regulations of the Client’s establishment to which attention has been drawn or which the Temporary Worker might reasonably be expected to ascertain;
 
8.4            Unless arrangements have been made to the contrary, conform to the normal hours of work in force at the Client’s establishment;
 
8.5            Take all reasonable steps to safeguard his own safety and the safety of any other person who may be present or affected by his actions on the Assignment and comply with the health and safety policies of the Client;
 
8.6            Not engage in any conduct detrimental to the interests of the Client;
 
8.7            Not at any time divulge to any person, nor use his own or any other person’s benefit, any confidential information relating to the Client’s or the Employment Business’ employees, business affairs, transactions or finances.
 
9.              TERMINATION        
 
9.1            The Employment Business or the Client may, without prior notice or liability, terminate the Temporary worker’s Assignment at any time.
 
9.2            The Temporary Worker may terminate an Assignment at any time without prior notice or liability.
 
9.3            If the Temporary Worker does not inform the client or the Employment Business (in accordance with clause 8.6) should they be unable to attend work during the course of an assignment this will be treated as termination of the assignment by the Temporary Worker in accordance with clause 9.2 unless the Temporary Worker can show that exceptional circumstances prevented him from complying with clause 8.6.
 
9.4            If the Temporary Worker is absent during the course of an assignment and the contract has not been otherwise terminated the employment business will be entitled to terminate the contract in accordance with clause 9.1 if the work to which the absent worker was assigned is no longer available for the Temporary Worker.
 
9.5            If the Temporary Worker does not report to the Employment Business to notify his availability for work for a period of three weeks, the Employment Business will forward his P45 to his last known address.
 
10.           LAW
 
10.1         These Terms are governed by the law of England & Wales and are subject to the exclusive jurisdiction of the Courts of England & Wales.

 
By signing this application, I declare that all information given by me is accurate and in no way misleading or false and i Agree to all the terms of conditions set out by Watergate Healthcare Limited