Healthcare File Sign OffLydian CareHealthcare File Sign Offto be completed by the recruiter who reviewed all of the candidates information to begin working - Healthcare sign offs need more information for the booking consultant to add onto pulse.Staff Members Name:* First Last Email Address* Were they Referred by a Friend (RAF)?YesNoName of Referrer:Enter Referer's Email Address if known: this will assist with issuing the voucher.Address* Street Address Address Line 2 City County Postcode NI Number:*Used by NHS to identify.DOB:* DD slash MM slash YYYY Contact Telephone Number:*Available to begin work from:* DD slash MM slash YYYY Sites/Area Available to Work:*Select all that apply. Downe Hospital Lagan Valley Ulster Hospital Royal Victoria Hospital Belfast City Hospital Mater Hospital Musgrave Park Hospital Craigavon Hospital Daisy Hill Hospital Lurgan Hospital Antrim Area Hospital Private SitesHolidays booked:*Sign off completed by:*Dean FosterCarla RiceAoibhinn McComiskeyNicola McCaughertyCaitlin O'TooleVia:* Zoom Telephone In PersonUniform & ID Badge Issued:* Yes NoUpload ID Badge Photo*Max. file size: 496 MB.Date ID Badge Issued:* DD slash MM slash YYYY Uniform Size*What size of uniformApplication & CV* Yes NoApplication Form & CV*Does the registrant's application form have all necessary info and a full work history?Access NI Docs* Yes NoNINO/POA/IDAccess NI Docs*Do we hold all necessary proof of ID including NINO/POA & Photo ID?Passport Number or Drivers Licence Number:*Required for healthcare staff as part of their profiles for sites.Date Passport Issued:* DD slash MM slash YYYY Date Passport Expires:* DD slash MM slash YYYY Date Access NI Received:* DD slash MM slash YYYY Access NI Status:* No Trace (N) TraceAccess NI Trace*Detail what is on the disclosureAccess NI Number:*NISCC Registration* Yes NoRegistered Since:* DD slash MM slash YYYY Registration Number:*If no - status of NISCC registration:*detail if awaiting endorsement, endorsed, paid for etc..Reference 1 Date Received:* DD slash MM slash YYYY Reference 1 Type:*EmploymentCharacterReference 1 Name:*Reference 2 Date Received:* DD slash MM slash YYYY Reference 2 Type:*EmploymentCharacterReference 2 Name*Online Training Completed on:* DD slash MM slash YYYY M&H Practical Training Completed on:* DD slash MM slash YYYY BLS Practical Training Completed on:* DD slash MM slash YYYY Health Declaration* Yes NoReviewed By*All vaccinations as required?* Yes NoUpload Health DeclarationMax. file size: 496 MB.Contract & Bank Details* Yes Noincluding listed NOK.Upload Bank Details*Max. file size: 496 MB.Date Sign off Completed:* DD slash MM slash YYYY Signed on behalf of Lydian Care:Signed on behalf of Lydian Care:Untitled
