I agree for you to contact these references and only once references have been received will my application go any further. I certify that the information on this form if the best of my knowledge correct. I understand that any engagement entered into will be subject to satisfactory references being received and a satisfactory DBS disclosure.
The Disability Discrimination Act 1995 defines a disabled person as anyone who has a physical or mental impairment which has a substantial and long term effect on their ability to carry out normal day to day activities.
FAILURE TO COMPLETE THIS FORM WILL NOT AFFECT YOUR APPLICATION. If you believe that there has been unfair discrimination in making the appointment, there is a process of investigation available, subject to reasonable grounds for suspicion being identified. If you wish to pursue an unfair discrimination complaint, please contact the Director of Blissful Healthcare.
I understand that I am under no obligation to work more than an average of 48 hours in any week - these hours include any hours that I work with other employers as well as Blissful Healthcare.
I furher understand that I may work more than 48 hours per week if I wish.
under the terms of engagement, I realise that I may turn down any assaignment at any time, for any reason without detriment.
By signing this declaration, I am signifying that any access of an average of 48 per week are worked by my choice, but also make it clear that this declaration does not mean that I will work more than an average of 48 hours in any week.
I undertake to inform if the total number of hours I work in a week from all forms of employment exceeds 48, in order that Blissful Healthcare may take this into consideration before offering work to me.
I understand that it is necessary to inform the agency of my availability for work each week and accept that there is no guaranteed hours of work.
In line with the requirements of current legislation I give Blissful Healthcare my permission to hold and transmit my photograph and date of birth, when necessary, to those clients who require identification cards when on assaignment for them.
I confirm that during every assaignment and afterwards:
1) To hold information relating to the client in the strictest confidence, ensure it is kept safely and securely when not in use. I acknowledge that no information is to be removed from the clients premises without the permission of the client.
2) To use such information only for the purpose of the week for which it was given.
3) Not to disclose to any third party or copy the information except as it required in the course of my duties.
4) Any breach, either by me or a third party, may result in legal proceedings being brought by the Client against me to recover any losses that have occurred as a result of a breach.
Any conversations that compromise the patient relating to the above statement may jeopardise my position with Blissful Healthcare.
I accept that I must wear a uniform together with black trousers and black shoes ( no high heels or trainers) on any care assaignment with Blissful Healthcare. Jeans and non - closed shoes are not acceptable.
I am happy to pay a total fee of £20
i understand that I must not wear my uniform when working for anyone other than Blissful Healthcare.
I also give permission to Blissful Healthcare, to make deductions from my wages for the cost of my uniform.
I understand and agree to the above:
When working in this industry there are hazards associated with the industry. I appreciate and accept that one of these hazards is possible aggressive behaviour from challenging service users. Service users may present challenging and aggressive behaviour and this is out of the control of Blissful Healthcare.
I understand and accept that I am under no obligation as an agency worker to accept assaignments. I accept that there is this risk and accept that this risk is as a result of the industry and not of Blissful Healthcare.
I understand that if I am unhappy with an assaignment I can withdraw my submission at any time with reasonable notice dictated in my contract for service, and as a result will not hold Blissful Healthcare liable for any injury or loss of earnings as an agency worker.
I understand that as an agency worker I am not employed by Blissful Healthcare and therefore I am not guaranteed any assaignments and have no claim against Blissful Healthcare at any time for any reason whatsoever for loss of any earnings as an agency worker.
I understand that if I am injured or affected in any other way whilst on an assaignment that this is not the fault or liability of Blissful Healthcare.
I understand and agree to the above in its entirely:
i also understand that I need to give at least 12 working hours notice if cancelling a shift or I will be charged a fee of up to £50, we understand there are certain situations that cannot be helped and we will always take these into consideration. When cancelling a shift I understand that I should call the office phone numbers as well as texting.
Failure to respond will result in us being unable to send you your payslip via email on a weekly basis as well as any communication relating to Blissful Healthcare’s activity.