Initial application form - other professions

Before we begin...
Registration with Medinet shouldn't take more than 8-10 days however there are some things we should let you know, before we start the process to ensure you have all of the information you need
Privacy policy
Please confirm you provide your consent for us to process your data in line with the purposes described in our privacy policy*

I consent
As part of processing your application we may conduct a criminal records (DBS) check in line with the Rehabilitation of Offenders Act. Before proceeding with this application, please confirm you provide your consent, should it be required to undertake a DBS/Disclosure Scotland background check. We also ask you to confirm at this stage that you do not currently have any unspent convictions.*

I understand
Please confirm you have a valid and current right to work in the UK*

I confirm I have a valid and current right to work in the UK

How did you hear about us?
Please tell us how you heard about us and what prompted you to register with us?*

I have been contacted by a member of the Medinet/Remedy TeamI have been referred by my own colleagueSearch engine (e.g. Google, Yahoo)I have been directed here from NHS Jobs/IndeedI saw a post on LinkedIn/Social mediaOther
Please provide their name*

Your CV and work history
Please ensure your CV includes at least your last 6 full years of employment historyworking backwards from the role you have told us about on the previous page. For any gaps in work longer than 3 months, please include an entry to provide a reason for this gap (e.g. Sabbatical, Family Break, Study Leave etc)

For any periods of time in Locum roles, please do not include details of the agency but rather the roles that you completed whilst on assignment as a locum.
Please upload an up to date copy of your CV in Word/ODT/PDF format*

CV Guidance: Please make sure your CV includes your work history up to today, with a clear indication of all previous roles, titles and locations, together with start and end dates. If your work history includes gaps in employment longer than three months, please tell us more about them (eg career break, family leave, sabbatical etc).
Cancelof
As a play specialist you will need to evidence experience and a Childcare Qualification at Level 3 or higher - please attach evidence of your childcare qualification*

Cancelof
If you would like to include any other supporting information or a personal statement please use the space below

Your references
Prior to continuing with the onboarding process, we will contact your referee(s) to ask for a reference confirming your dates of work and duties.

Please note, one of your references must be from a Band 7 or higher clinician working within the NHS

If you submit your application and your references do not meet this criteria, we may contact you or reject your application.
Reference 1 - NHS Band 7+ only
Their Name

First NameLast Name
Their email address*

Confirmation Emailexample@nhs.net
Their home trust/hospital*
Reference 2
Their Name

First NameLast Name
Their email address*
example@nhs.net
Their employing organisation*
I consent to Medinet Clinical Services Limited to contacting the above referees for the purposes of validating the information provided in this application form.*

Clear
Print your name*

First NameLast Name
Date*

DayMonthYear
Date

Off payroll working
In providing your services to Medinet on an off-payroll basis, to support your own self-employed/outside IR35 status as well, as our own compliance obligations, it is helpful to evidence that you are indeed operating in business on your own account. We would be grateful if you can please therefore answer the following questions:
Can you confirm if you provide your services to private and independent sector providers? For clarity, this should not include any situation where you may be working for the NHS as an employee.*

YesNo
Will you be providing your services to others concurrently with your engagement with Medinet?*

YesNo
Will your engagement with Medinet be your main source of income?*

NoYes
Please provide background as to why this is the case.*

Declaration
Being registered to work with us at Medinet doesn’t guarantee we’ll be able to offer you any work – and there’s no obligation for you, as an independent contractor, to agree to any work we might offer.

Although there’s no legal obligation for you to agree to any work we offer, we do have a cancellation policy, so that we don’t let our clients down. If you agree to take on a period of work, you’ll need to give us ample notice if you need to cancel, in line with this policy
I confirm that the information provided in this form and my CV is true and correct to the best of my knowledge*

I Agree
Signature*
Date*

DayMonthYear
Print your name*

First NameMiddle NameLast Name
If we are unable to offer you immediate work, we will keep your information on file and will contact you to complete onboarding at a later date. If you'd rather we didn't keep your information on file for furture opportunities, please untick the box below.

Consent
Please verify that you are human*
Should be Empty:

Clinician type	Example	Registration requirement
Allied Healthcare Professionals	ODP, Orthoptists, Radiogrtaphers	Health and Care Professionals Council (HCPC)
Clinical physiologists & Healthcare Scientists	Audiologists & Sleep, Cardiac, Respiratory Physiologists	Registration Council for Clinical Physiologists (RCCP) or pSA Accredited Academy for Healthcare Science (AHCS)

	Anaesthetics	Scrub	Circulate	Recovery
Abdominal
Breast
Cardiothoracic
Colorectal
Dental
Dermatology
Endocrine
ENT
General
Gynaecology
Nerve blocks
Neurosurgery
OMFS
Ophthalmology
Ophthalmology - Corneal
Ophthalmology - Stents
Ophthalmology - Trabeculectomy
Ophthalmology - Oculoplastics/DCR
Ophthalmology - Vitreo-retinal
Oral
Orthopaedic
Pain
Plastics
Radiology
Spinal
Thoracic
Urology
Vascular

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