Locums Limited - Apply Now

	01756 703 892
	e-mail: info@locumslimited.com

To apply, you may complete this form or click here and download the application form.

* Required Fields

[A] ABOUT YOU

Title: *

Surname: *

Forename: *

Gender: *

Address: *

Postcode: *

Mobile: *

E-mail: *

Date of Birth:*

Nationality:*

Occupation:

National Insurance No:
eg.

AA 999999 A

How did you hear of us?

[B] YOUR UK BANK DETAILS
Name of Bank:*
Name of Bank Branch:
Name of Account Holder:*
Branch Sort Code :*	- -
Bank Account Number :*
Building Society Reference Number:
If you do not have a UK bank account please tick here

[C] YOUR RECRUITMENT AGENCY DETAILS

[1] Name of Agency/Client:*

Contact Person:*

Contact No.:

Rate:

PAYE/ Ltd. Co.:

Pay Interval:

Click to Add More Agency

Do you have full time employment with any NHS hospital in UK ?* Yes No

Do you have any employer outside UK? * Yes No

Name of Employeer outside UK:*
Country of Employeer outside UK:*

[D] YOUR RIGHT TO WORK*
One of the following is necessory to complete your application. Please indicate type of document you intend to provide to verify your Right To Work in UK.
	British Passport
	EU passport
	Other passport showing entitlement to work in the UK.
	Other passport and a Residence permit issued by the Home Office in UK.
	Any other passport and certificate of Naturalization.
	Any passport or letter issued by the Immigration and Nationality Directorate.
Expiry date of right to work :

	I confirm that the above details are correct and my services are of a self employed nature. I am entitled to work in the UK and enclose a copy of supporting documentation.
	I have read and understood this contract and hereby agree to employment with Locums Limited as mentioned in the Terms and Condition from
Upload RTW (Copy of Visa/Passport) :

	*Please note, to complete registration process we will send you some forms through post.