Associates registration form

Associates registration form

Please complete fully to register with us for works on a freelance, self employed basis.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Please advise grade/skills level*
Role(s) applied for, in which you have experience and/or suitable qualifications- you may select more than one for which you are competent.*

First Responder (medic)Fire marshallStewardEvent ControllerLifeguard (swimming pools etc)Traffic marshal/stewardEvent loggerSecurity, holding SIA DS registrationWater rescue technician (lakes and mainly still bodies of water)Water rescue technician (rivers and moving water)Water rescue technician (tidal waters)Paramedic (HCPC)Ambulance technician/FREUC5/AAPOther
Date of Birth*

DayMonthYear
Date
Please upload a copy of your relevant medical training certificate- FREC, AAP, Ambulance Aid, Para registration, Lifeguard etc

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For medical roles, Please confirm (if you do not have AED, please use last option and advise us as AED is essential and not having one will limit work we can offer):*

I have full response kit for my grade including AEDI have oxygenI have nitrous oxideI am a paramedic and have full drugs and CDsI am AAP/Tech and have drugs for my skills gradeI have 12 lead (Tech/AAP and para grade)I have kit but no AED and appreciate this will limit work offeredI do not have any kit and appreciate this will limit work offeredI can access kit and bring with me when required including AEDI am not applying for medical role
Please confirm:*

I have my own private car /vehicle to get to/from work locations that is insured for business (variable work locations) usageI have my own marked car to get to/from work locations that is appropriately insuredI use public transport to get to/from work
Please upload a copy of the back of your driving license

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Please upload a copy of your CV in word or PDF format*

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If you hold a DBS, please provide details of your DBS that must be on the update system,- we need number, date of certificate. we will also need to see your DBS - please either upload a copy below or contact us to arrange viewing
For medical roles, please upload a copy of your DBS showing all pages

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Please confirm:*

my DBS is "clear"my DBS has criminal records on it and I will send a copy to you to review and risk assessI am not applying for a medical role
Do you have "off road 4x4 training" - if yes please provide details of what training and when you did this
please advise your available (E.g.- freelancer any day by arrangement, around my NHS shifts, I have a full time job....)*
Please advise your expected hourly rate*
Please confirm you have rights to work in the UK and can provide proof on request*
Please register me for adhoc works with you. I understand that all works are as and when and there is no guarantee of work levels.

I am freelance, self employed and no contract of employment will be created by these works.

I will update you of any changes to my circumstances including removal of registrations that may affect my grade or ability to work.

I will not solicit, attempt to solict or directly enage with any client for work nor will I advise others of the clients I work for in an attempt to get themto contact the client for work.

If I work direct for a client for whom I was first introduced via CHSS, then I understand a recruitment fee of £2000 will be immediately payable.

I confirm I will keep my kit in full working order, all within expiry date and in good condition.

If a medic, I will wear unbranded greens on duty and clean black boots, unless a revised dress code is advised. For all other roles I will wear as requested.

My language and behaviour will remain professional at all times and I understand I must be visible, on set, for TV work where I can be accessed.

Any breaks taken are to be deducted from invoice fees and if I smoke (which includes vape) I must not go off duty to smoke and only smoke at agreed breaks out of sight of client and public

I wil invoice after works are done on 30 day payment terms.

A full contractor agreement is available if I chose to ask for it
My signature agrees to the terms of service *

Clear
Please upload a copy of the front of your driving license

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