SmartWork - Umbrella Application

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

1. About You

Title    First Name *        Middle Name         Surname *    
Date of Birth *      Gender *
National insurance number Nationality *  
Home telephone number
Email address *

Mobile number *
Secondary Email
Professional qualifications held:   *Send certificates/CV
Permanent address:
Address Line 1:*   Address Line 2:
Town/City:*   County:
Postcode:*   Country:

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

Name of bank/building society*   Name of account holder:*  
Sort code: *  -    -     Account number *         
Please check the details above before submitting your application as SmartWork cannot be held responsible for monies released to incorrect bank details.

3. Agency Details

Agency name*   Branch location
Contact telephone number  *   Name of consultant: *  
Consultant email address  *  
Agency Address

4. Assignment/Contract Details

Contract start date  *   Contract End date
Job Title  *   End Client Name *  
End Client Contact End Client Address
Are you currently working for this client? If yes, how long for?
Have you worked at the same site in the past 3 months
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 or upload it below.

5. How did you hear about us?


6. Next of Kin Details

Next of kin name
Home telephone number Mobile number:  

7. Medical

Do you work in the Medical Sector?

Registration and Licensing

   Registration and Licensing    Membership Number    Valid Until
   Medical Unions and Societies    Membership Number    Valid Until
Location of work

Under the SmartWork Medical Insurance policy contractors are required to hold their own insurance policy, save where their work is exlusively carried out in the NHS, where the NHS indemnity scheme applies to all who provide services to the NHS. NHS comprises of the secondary care trust hospitals and clinics. The following areas of work are not covered GPs (including fundholders), general dental practitioners, family dentists, pharmacists or optometrists; other self employed health care professionals eg independent midwives; employees of FHS practices; employees of private hospitals; local education authorities; voluntary agencies. Please see details of the scheme at

All medical practitioners, dentists, nurses or midwives shall hold valid licences to practise in their respective specialisations and maintain registration with the GMC, GDC, NMC or equivalent organisation at all times.

All medical practitioners, dentists, nurses or midwives shall belong to and shall subscribe to the Medical Defence Union or Medical Protection Society or the Royal College of Nursing or Royal College of Midwives or other equivalent organisation or shall be otherwise insured under a separate Policy of insurance against their own malpractice, professional acts, errors, omissions or negligence.

If you are working for a private medical practice 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 you will not be able to work through SmartWork.

8. Payment Preference

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

9. Employee statement (New Starter Checklist)

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

  • 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)

10. Student Loans

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

11. Holiday Pay

Please confirm your preferred option

12. Next Steps

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, via fax to 0117 3763737 or post to: Ltd, Whitefriars, Lewins Mead, Bristol, BS1 2NT

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

13. Identification - Right to Work Checks

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: SmartWork will require this code to start the on boarding process. Share codes can be sent to

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

14. Acceptable Documents for Proof of Address

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.

15. Health and Safety

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

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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