AGENCY WORKER REGISTRATION & ASSESSMENT FORM :
Are you a Nurse or Healthcare assistant in Ireland and want to work temporary/locum shifts in Nursing homes and Hospitals nationwide? As an agency staff member, you would be required to take on shifts to cover staff shortfalls for our employers due to Illness, Injury, Annual leave, COVID situations etc. If you are interested then please fill out the below form as a first stage of registration with Hollilander. You can contact us through Whatsapp at +353 872763474 for any further queries.
Full Name
*
First Name
Last Name
Date of Birth
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
What is your Profession?
*
Please Select
Nurse
Healthcare Assistant
Other Health Staff
What is your specialty?
*
Total Years of Experience in Irish Healthcare sector?
*
Which shifts do you prefer to work?
*
Day Shift
Night Shift
Both
Preferred location of work?
*
What is the maximum distance you are willing to travel for assignments?
*
Are you available to work Nationwide?
Do you hold Irish Driver's License. If other, then please specify.
*
Do you have your own transport?
*
YES
NO
Are you fully vaccinated against COVID-19?
*
YES
NO
Are you available to work in a Covid Situation?
*
YES
NO
Would you be able to accept next day shift?
*
Approx. how many days are you planning to work in a week?
*
1 Day
2 Days
3 Days
4 Days
Full time
Do you have any of the following certificates/documents
NMBI PIN Number/QQI LEVEL 5
Manual handling
BLS
Address proof
Photo ID
COVID certificate
Please specify your residency status
*
Irish/EU Citizen
Stamp 4
Stamp 1G
Any other
Please specify, if other residency status
Any message?
Submit
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