SmartWork - Umbrella Application

1. About You

2. Payment Details(must be the employee’s personal account details with a UK bank)

3. Agency Details

4. Assignment/Contract Details

5. How did you hear about us?

6. Next of Kin Details

7. Medical, Health Care and Social Worker

8. Payment Preference

9. Employee statement (New Starter Checklist)

10. Student Loans

11. Holiday Pay

12. Next Steps

13. Identification - Right to Work Checks

14. Acceptable Documents for Proof of Address

15. Health and Safety

Enter the name of your point of contact at SmartWork here:

Title First Name * * Middle Name Surname * *

Date of Birth *

* Invalid date format. Gender *

Male

Female

National insurance number

Nationality *

Home telephone number
Email address *

*
Please Enter Valid Email ID

Mobile number *
Secondary Email

* Enter valid mobile number
Please Enter Valid Email ID

Professional qualifications held:

*Send certificates/CV

Permanent address:

Address Line 1:*

Address Line 2:

Town/City:*

County:

Postcode:*

Country:

Name of bank/building society*	*	Name of account holder:*	*

Sort code: *	- - *	Account number *	********

IBAN

Please check the details above before submitting your application as SmartWork cannot be held responsible for monies released to incorrect bank details.

Contract start date *

Contract End date

Job Title *

End Client Name *

Rate (Must be £15.50 or greater to register) *

Please enter Rate

Working Hours (Full or Part Time)

End Client Contact

End Client Address

Are you currently working for this client? If yes, how long for?

Yes

Have you worked at the same site in the past 3 months

Yes

Please note- If your agency/client has already sent you a copy of the Assignment Schedule or Booking Form with details of the role can you please forward this to contracts@smartwork.com or upload it below.

Please select at least one item.

Other

Next of kin name

Home telephone number				Mobile number:

MEDICAL REGISTRATION AND LICENSING (ONLY APPLICABLE FOR MEDICAL WORKERS)

Do you work in the Medical, Health Care or Social Work Sector?

Yes

Doctors/Medical Practitioners, Midwives & Dentists.

Our Medical Malpractise does NOT cover Doctors/Medical Practitioners, Midwives & Dentists. If working in these professions for the NHS or for a private medical practice/clinics/GP surgeries, you will need the appropriate medical professional liability insurance which should reflect the risks associated with the scope of your practice and provide sufficient cover if a claim is made against you. A copy of this policy needs to be shared with SmartWork at the on boarding stage and kept up to date on an annual basis.

All medical practitioners, dentists, midwives shall hold valid licences to practise in their respective specialisations and maintain their own professional medical negligence against their own malpractice, professional acts, errors, omissions or negligence.

Nurses and Healthcare Professionals (Non-Clinical)

Under the SmartWork Medical Insurance policy, Nurses and Healthcare Professionals (Non-Clinical) are required to hold their own insurance policy, save where their work is exclusively carried out in NHS Trust, where the NHS indemnity scheme applies to all who provide services to the NHS. NHS comprises of secondary care trust hospitals but not independently run private medical practices/clinics/GP surgeries. You will not be covered by the RCN scheme for your practice under a contract of employment as this is their policy, whether working in the NHS, non-NHS public sector, or independent health care sector

All Nurses and Healthcare Professionals (Non-Clinical) shall hold valid licences to practise in their respective specialisations and maintain registration with the NMC/RCN or equivalent organisation at all times

Private Medical Practices/Clinics/GP surgeries

If you work for a private medical practice/clinics/GP surgeries, you must provide SmartWork with a copy of the appropriate medical professional liability insurance. This should reflect the risks associated with the scope of your practice and provide sufficient cover if a claim is made against you. If you cannot provide us with a copy of your insurance, you will not be able to work through SmartWork.

Registration and Licensing

Registration and Licensing	Membership Number	Valid Until
General Medical Council (GMC)
Nursing and Midwifery Council (NMC)
Health and Care Professions Council (HCPC)
Social Work England
Other

Medical Unions and Societies	Membership Number	Valid Until
Medical Defence Union
Medical Protection Society
Royal College of Nursing
Royal College of Midwives
Other:

Location of work

NHS

Private Medical Practises

Both

Please let us know if you are to be paid weekly or monthly (this is dependent on your Agencies invoicing cycle) and also tick your preferred payment option
If you are aware of your Agencies invoicing cycle, please confirm

Weekly

Monthly

Unknown

If you do not wish to receive your full salary and bonus upon receipt from the Agency, opt out by ticking the box

You need to select only one of the following statements A, B or C:

A - This is my first job since last 6 April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.

B - This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker’s Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a State or Occupational Pension.

C - As well as my new job, I have another job or receive a State or Occupational Pension.

Please also send us a copy of your original P45 which must have been issued within the last 3 months, (if you do not have a P45 then we can use the New Starter Checklist)

Tell us if any of the following statements apply to you:

you do not have any Student or Postgraduate Loans
you’re still studying full-time on a course that your Student Loan relates to
you completed or left your full-time course after the start of the current tax year, which started on 6 April
you’re already making regular direct debit repayments from your bank, as agreed with the Student Loans Company

Tell us if any of the above statements apply to you

Yes

Please confirm your preferred option

Accrued Holiday Pay (we pay holiday pay when you are on holiday or request your holiday)

Advance or rolled up holiday pay (this is paid out to you on a weekly/monthly basis)

In order to comply with the Asylum and Immigration Act 1996, we will require evidence of your identity before you commence employment.

We have included a list of acceptable forms of ID and proof of address below.

Please upload copies of your ID and Proof of Address below or email to info@smartwork.com, via fax to 0117 3763737 or post to: SmartWork.com Ltd, Whitefriars, Lewins Mead, Bristol, BS1 2NT

If you have any problems obtaining the correct documentation please let us know.

From 1st October 2022 SmartWork must carry out right to work checks before we can employ a worker. The Right to Work check for British and Irish passport holders is done via Trust ID who are experts in identity document verification services and a certified IDSP. Using identity document validation technologies (IDVT) it can help us quickly and easily to establish the authenticity of documents for identity verification purposes, including passports, biometric residence permits, driving licences, visas and identity cards. Our Right to Work service is accessible via a secure online portal or via an App on your smartphone or tablet device which will be emailed to you by our compliance team.

Any non UK or Irish passport holders can prove their immigration status by generating a share code: gov.uk/view-prove-immigration-status. SmartWork will require this code to start the on boarding process. Share codes can be sent to compliance@smartwork.com.

Please note we cannot employ workers and process contracts prior to these checks being carried out.

You’ll need one of the following:

your biometric residence permit number
your biometric residence card numberr
your passport or national identity card

Share Code

You need to send 1 of these, documents must show your full address and postcode and include at least your initials and surname.

Original Gas, Electricity or Telephone bill (must show your phone number), no more than 3 months old.
Original Water bill, no more than 12 months old.
Original Bank, credit card or Building Society Statement, no more than 3 months old from an active account.
Original current Local Council rent book or Local Council Tenancy Agreement.
Original current Council Tax Bill less than 12 months old.
Original Mortgage Statement from a recognized lender, less than 12 months old.
Original Inland Revenue document less than 12 months old. Not a P60 or P45.
Original TV Licence Reminder or Vehicle Licence Reminder no more than 12 months old.
Original current Known Housing Association Tenancy Agreement or current Known Housing Association rent book.

Agency name*

Branch location

Contact telephone number *

Name of consultant: *

Consultant email address *

Agency Address

I can acknowledge I have read and understood the following relevant Health and Safety information.

SmartWork.com Health and Safety Handbook
Client's Health and Safety Information(including but not exclusive list Welfare arrangements Fire and First Aid information means of reporting accident / incidents)

By checking this box you are agreeing to comply with the policies and procedures contained within the Health and Safety Handbook *

SmartWork takes its responsibilities for Health and Safety very seriously and tries to work with likeminded clients. As the provision of your Services is being delivered outside our area of control, your Health, Safety and Welfare will be the responsibility of SmartWork. Should you have any concerns regarding Health and Safety please initially discuss these concerns with your SmartWork Business Manager. If you do not receive a health and safety induction by the client please let your business manager know.

Please provide your documentation before you commence employment

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