NHS HIGHLAND
INTERNAL REGISTRATION FORM FOR NEWLY QUALIFIED BANK
NameAddress
Date of Birth / Mobile Phone No
E-mail address
Email address (repeat)
Note: Communication regards your application will be by e-mail so it must be legible!
Post held in NHS HighlandCurrent Band / Pay Number
Any other posts held, location and hours
HCPC/ NMC Pin No / (If known)
Reg Renewal date
STATUTORY/MANDATORY TRAINING RECORD - MUST BE UP TO DATE
Training / Date completed (i.e. 01/01/2016)Violence & Aggression (Induction or update)
V&A 3 Days Restraint (New Craigs only)
Moving and Handling(Induction or Competency Assessment)
NHS Highland Medication Management (LearnPro)
Fire Training (LearnPro)
Basic Life Support (Sharon Fraser 01463 255817)
Hand Hygiene
Occupational Exposure (Sharps) Programme(LearnPro)
Falls Awareness (LearnPro)
Safe Transfusion Practice (LearnPro)
Safe Information Handling (LearnPro)
SUPPORTING MENTOR – Statement of Support
I will mentor and support...... in the transition from student to newly qualified Nurse, Midwife or Allied Health Professional. I will inform the Integrated Staff Bank when they are confident and competent and can work as bank NMAHP in other locations. I will be KSF/PDP Reviewer and support with Flying Startuntil such time as a substantive post is secured.Name (Print):
Signature:
Date:
Location:
Email address:
STATEMENT FROM SIGN OFF MENTOR (IF NOT SUPPORTING MENTOR):
I can confirm that I support / do not support ...... in his/her application to join the Integrated Staff Bank as a newly qualified NMAHP.
Comments:
Name (Print):
Signature:
Date:
Location:
Email address:
Newly Qualified Staff Bank Data Collection Form
The sections highlighted with an asterisk are mandatory fields for completion, all other sections are optional. Please complete all sections which are appropriate to you and return immediately to the address below:
Qualified Staff Registration;٭NMC/HCPC No / NMC/HCPC Expiry Date
Please tick appropriate box(es) to indicate your professional qualification(s)
RSCN / RMN / RNA / RM / RNLD / REN
RD / ROT / RRAD / RSLT / RPT / RP
Next of Kin details
Title (eg. Miss/Mr/Mrs/Ms)٭
Name ٭
Relationship (eg. Partner, husband) ٭
Address (if different)
Town٭
County٭
Postcode ٭
Telephone No٭
Work Permit Details *
Do you require a work permit? (Y/N)
Work Permit Number
Work Permit Type
Date Work Permit Expires
Contact
Please tick appropriate box(es)
Are you happy to receive cold calls in relation to bank shifts Y / N
Are you happy to receive Text Messages Y / N
(please circle as appropriate)
Special requirements for working
Please tick box(es) if answer is ‘yes’ to any of these questions
Do you have any disabilities?
Do you have any special needs?
Is any adaptation required when on duty?
Please give any details in space below:
Confirmation of Above Details
Signature: / Date:
Name (Print)
Dear Applicant please note:
- Before starting work as a newly qualified NMAHP you will be contacted by the Integrated Staff Bank by e-mail and you will be issued with a Uniform Request Form, confirmation to take to Estates for issue of new ID and you will be required to complete a Change Form.
- When the process is complete you will receive a letter by e-mail from the Integrated Staff Bank, until then you can continue to work as a band 2 HCSW but should not book shifts as a band 5 NMAHP.
- When you are successful in securing a substantive post please inform the Integrated Staff Bank of the location and contracted hours.
- Completion of Flying Start is recommended for newly qualified bank NMAHP’s.