I can confirm that I have read this document fully and that all the information provided to Eleventh Hour Medical Ltd is correct and to the best of my knowledge and belief. I give consent to contact referees regarding the information I have provided unless specified otherwise. I will inform Eleventh Hour Medical Ltd should anything change that might affect my position and I understand the information given on this form will be processed by computer and used for registration purposes, under the Data Protection Act 1998.
1. I understand that if I am at any stage charged or cautioned after signing this declaration, I must inform Eleventh Hour Medical Ltd.
2. I acknowledge that I have been given a copy of the terms and conditions of service issued by Eleventh Hour Medical Ltd, which is mine to keep, and furthermore that I have read those terms and conditions and agree to abide by them.
3. 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 Form.
4. I acknowledge and confirm that Eleventh Hour Medical Ltd is authorised to apply for and obtain a Disclosure and Barring Service (DBS) check and references from any previous employers and educational establishments.
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 Eleventh Hour Medical Ltd may cease to offer me further agency placements without notice, as well as claim for recovery of any payments I have received, together with a claim for loss of profit to Eleventh Hour Medical Ltd.
6. I agree that the maximum weekly working time specified in Regulation 4(1) and (2) of the Working Time Regulations 1998 shall not apply to working with Eleventh Hour Medical Ltd unless specified above.
7. I acknowledge that my personal details will be stored and handled correctly by Eleventh Hour Medical Ltd in accordance with the Data Protection Act 1998, however, I agree that they may be made available for audit/review by relevant third 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 Eleventh Hour Medical Ltd.
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 Eleventh Hour Medical Ltd.
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 Eleventh Hour Medical Ltd, I must inform Eleventh Hour Medical Ltd immediately.
11. I confirm that I am not currently under investigation, or currently suspended, by my professional regulatory body or being investigated by my current or previous employer. I will inform Eleventh Hour Medical Ltd if I am under investigation or suspended by my professional regulatory body or employer at any point while working for Eleventh Hour Medical Ltd.
12. I confirm that when asked about my working history (primarily, but not exclusively, for the purpose of the Agency Workers Regulations) I will provide accurate information.
13. I acknowledge that should I reach the 12 week Qualifying Period under the Agency Workers Regulations, I may
be asked for, and will provide, further documentation as evidence of qualifying weeks, if Eleventh Hour Medical Ltd deem it necessary.