Registration Form for Clinical Personnel

Registration Form for Clinical Personnel

Please complete this form to register your interest in working with Intemed. All information will be handled confidentially.
Personal Details
Full Name

First NameLast Name
Home Address

Address Line

Address Line
Town or CityCountyPostcodeCountry
Date of birth

DayMonthYear
Date
Nationality
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: 00000000000.
Right to Work
Right to Work Status
Visa Expiry Date (if applicable)

DayMonthYear
Date
Professional Details
Profession
Regulatory Body
Registration Number
Primary Specialty
If possible, please submit your CV.

Cancelof
Declarations
Job Alerts & Communications
Safeguarding / Pre-Engagement Checks

I understand that any offer of engagement or placement will be subject to satisfactory pre-engagement and safeguarding checks, which may include an enhanced DBS check where required for the role. I agree to cooperate fully and promptly with all pre-engagement checks requested by Intemed Ltd. I acknowledge that if any check returns an unsatisfactory result — whether before or after the commencement of an engagement — Intemed Ltd reserves the right to withdraw any offer or terminate any engagement, subject to the applicable terms of engagement.
Fitness to Practise Declaration

I confirm that I am fit to practise and, where applicable, hold current registration with the relevant professional regulator. I confirm that I am not subject to any current restriction, condition, suspension, undertaking or open regulatory investigation that would affect my suitability or ability to undertake clinical work. I agree to notify Intemed Ltd in writing without delay if my professional registration, regulatory standing or fitness to practise changes at any point during the application or engagement process. I understand that Intemed Ltd reserves the right to take appropriate action in the event that information provided is found to be false or misleading.
Data Processing and Declaration

By submitting this form and uploading my CV, I confirm that the information provided is true and accurate to the best of my knowledge and that I am entitled to share the documents and information submitted, including any third-party personal data contained within them. I understand that Intemed Ltd acts as the data controller for the personal and professional information provided through this form. My information will be collected and processed for recruitment, suitability assessment, credentialling, compliance verification, and potential clinical engagement or placement. Where necessary for those purposes, Intemed Ltd may share my CV, contact details, and relevant supporting information with authorised third parties involved in recruitment, clinical review, compliance, verification, or placement activity. I understand that my personal data will be retained for a period of up to 2 years following the conclusion of my application or engagement, in accordance with Intemed Ltd's data retention policy. I acknowledge that I have read and understood Intemed Ltd's Privacy & Cookie Policy and am aware of my rights under UK GDPR, including my right to access, rectify, or request erasure of my personal data by contacting Intemed Ltd at info@intemed.co.uk. I confirm that where I have provided third-party personal data, I have obtained the necessary authority to do so.
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Registration Form for Clinical Personnel

Personal Details

Right to Work

Professional Details

Declarations