Promote positive behaviour

Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

Dear Colleague
Welcome to the Substantive Registration process – we are delighted that you are looking to join NHSP’s Staff Bank as a Substantive Worker.
In order to make the process as simple as possible, you will need to do the following: •

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Complete page 3 of this registration form – please use capital letters when completing this form.

Take the form to your line manager and ask him/her to complete page 5 (line manager details/authorisation) and the assignment codes on page 6.

Make an appointment with your local Trust Liaison Co-Ordinator – do NOT send your paperwork until your documents have been verified by your TLC.

Attend appointment with your TLC and bring with you this completed registration form and the following documents:

Proof of ID/Right to Work + Photocopy
Valid Passport (any nationality) + valid Visa or Work Permit – if applicable Foreign Nationals – if your visa is in an expired passport, you will need to bring both the expired passport and your current one

Valid Photo Identity Card (EU Countries only)
OR (for full UK Nationals ONLY)
UK Birth Certificate (Full/Long – issued within 12 months of date of birth.
Short birth certificates are not acceptable)
Certified evidence of name change if the surname is different to the Birth Certificate, e.g. Marriage/Adoption Certificate/Deed Poll
Trust Payslip – dated within the last 3 months + photocopy showing all 4 corners of the payslip One passport sized photograph – name printed on reverse

Working Time Directive Opt Out Form

P46

Evidence of Professional Registration (NMC, AHP, etc Pin Number) – if applicable Failure to provide your TLC with the above documents
will prevent your application from being processed.

1

Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

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Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

Personal Details – to be completed by the applicant (using CAPITAL LETTERS) Title: __________

Name: ________________________

Previous Name: ________________________

Contracted Trust: _________________ Location: __________________ Ward: _______________________ Present Post: _______________________________

Contracted Hours: _____________________________

Date of Birth:

E-mail Address: _______________________________

_____________________________

Home Telephone Number: ____________________

Mobile Number: ______________________________

Address: _________________________________________________________________________________ ___________________________________________

Post Code: _________________________________

NI Number:

Nationality: __________________________________

Female

Male

Bank Details
Bank/Building Society: _________________________________

Branch: _______________________

Account Holder’s Name: ________________________________

Roll Number: ___________________

Account Number:

Sort Code:

Emergency Contact Details
Name: __________________________________

Relationship: ____________________________

Telephone Home: _________________________

Telephone Work: _________________________

Telephone Mobile: _________________________
Declaration
I declare that the information provided on this form is correct and that I will advise NHS Professionals of any changes in writing. I consent to the disclosure of the information from this form between NHS Professionals and NHS Shared Business Services for HR and Payroll purposes.

I understand that the details on this form will not become valid until I have successfully completed the registration process. Signed: _____________________________________________________________

Date: _____________________________

If your status changes for any of the following reasons you MUST advise us immediately in writing: Leave contracted post
Change in contracted hours
Change of name, address, telephone numbers
If you should need to contact us by telephone, the number can be found by visiting www.contact.nhsprofessionals.nhs.uk and choosing the Trust that you
work at.
FOR COMPLETION BY NHSP
Job Title
Staff Role
Assignment(s) Codes
Registration Process completed by
Date
FOR COMPLETION BY SBS PAYROLL
Input onto ESR by

Flexible Worker

Enclosed
Form P45
Form P46
Form P38S
SD502
Date

3

Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

Check List – to be completed by NHSP Representative
Name of Substantive Employee: ___________________________

Trust: _________________________

NI Number: _____________________________
Proof of ID/Right to Work + Photocopy
Valid Passport (any nationality) + valid Visa or Work Permit (if applicable) Foreign Nationals – if the visa is in an expired passport, gain copies of both the expired passport and the current one, including Bio pages

Valid Photo Identity Card (EU Countries only)
OR (for full UK Nationals ONLY)
UK Birth Certificate (Full/Long – issued within 12 months of date of birth. Short birth certificates are not acceptable)
Certified evidence of name change if the surname is different to the Birth Certificate, e.g. Marriage/Adoption Certificate/Deed Poll
Trust Payslip – dated within the last 3 months + photocopy showing all 4 corners of the payslip One passport sized photograph – name printed on reverse

Assignment Code Form – signed by Line Manager. Review codes with applicant and refer to Line Manager if necessary
Registration/Appointment Form – fully completed, bank details confirmed and signed by applicant .
Signed copy of the Flexible Worker Registration document – name, address, signature and date completed on front page
Working Time Directive Opt Out Form

P46

Evidence of Professional Registration (NMC, AHP, etc Pin Number) – if applicable

Pin Number: ___________________________

Expiry Date: _____________________

NHSP Verification
Name:

_________________________________________

Position:

_________________________________________

Signature:

_________________________________________

Date:

__________________

If you have any questions relating to any of the above, please call the Substantive Registration Team on 01923-699929

4

Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

Manager Details – to be completed by Ward/Line Manager

Manager’s Name:

________________________________________

Job Title:

________________________________________

Ward:

________________________________________

Trust:

________________________________________

Contact Telephone Number:

________________________________________

E-Mail Address:

________________________________________

Name of Substantive Employee: ________________________________________ NI Number:

________________________________________

I can confirm that the person named above as a Substantive Employee has an NHS contract with the Trust and that the following checks were completed on their appointment/registration:

Two Satisfactory References

Occupational Health Screening Completed

Enhanced CRB Disclosure carried out

Mandatory Training completed in the last 12 months
(Fire, moving & handling, infection control and CPR)

I can confirm that the assignment codes selected over are correct.

Signature:

_______________________________

Date: ________________

(Please see over the page to select the assignment codes)

5

Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

Nursing & Midwifery Staff Group – to be completed by Line Manager Please select the assignment type/s from Box 1 and then all appropriate codes in Box 2, including General Acute (00) if the Substantive Worker has the relevant experience/qualifications. Substantive Employee Name: _____________________________________ Line Manager Name:

_____________________________________

Line Manager Position:

_____________________________________

Line Manager Signature:

_____________________________________

Box 1 Assignment Type

Care Support Worker (CSW)

Nurse Advanced (NAD)

Registered Midwife (RM)

Care Support Worker Higher (CSWH)

Nurse Associate Practitioner (ASP)

Registered Nurse (RN)

Community Psychiatric Nurse (CPN)

Nurse Associate Practitioner Higher

RM Preceptorship (RMP)

Dental Nurse (DN)

Nurse Consultant (NC)

RN Preceptorship (RNP)

Dental Nurse Team Leader (DNTL)

Nurse Modern Matron (NMM)

Senior Community Support Worker (SCW)

Emergency Nurse Practitioner (ENP)

Nurse Team Leader (NTL)

Theatre Practitioner (TP)

Health Visitor (HV)

Nurse Team Manager (NTM)

Theatre Practitioner Entry Level (TPEL)

Health Visitor Specialist (HVSP)

Nursery Nurse (NN)

Theatre Practitioner Higher (TPHL)

Midwife Modern Matron (MMM)

Project Worker (PW)

Theatre Practitioner Team Manager (TPTM)

(ASPH)

Midwife Team Manager (MTM)

Box 2 Area of Work

Accident & Emergency
Cardiology
CATS Recovery
Child Health (Hospital)
Coronary Care Unit
Day Surgery
Elderly Care
Endoscopy
ENT
Family Planning
General
Genitourinary
Gynaecology
High Dependency Unit
Infection Control
Intensive Care Unit
Liver Unit
Maternity
Neurology
Community
General
Schools
Mental Health
General
Adult – Rehab
Adult – Continuing Care
Adult – Acute
Child & Adolescent

Code
04
13
135
60
05
43
17
16
44
68
00
19
45
07
36
08
22
66
23

Acute

Neurosurgery
NICU
Oncology
Ophthalmology
Orthopaedics
Paeds A&E
PICU
Plastic Surgery & Burns
Prisons
Renal
Sexual Health
Theatre Anaesthetics
Theatre Circulator
Theatre Recovery
Theatre Scrub
Theatres General
Trauma & Outpatients
Urology

Code
48
62
24
49
54
63
61
51
131
29
95
40
57
52
55
59
94
56

102
111

Child Health (Community)

100

03
72
71
70
73

Older Persons Learning
Disabilities
Forensic
Substance Misuse/Addictions
Community Mental Health

79
77
76
74
120

6

Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

Agreement to work more than 48hrs per week

In addition to the paragraph detailing your normal hours of duty in your terms and conditions of engagement with NHS Professionals, you specifically agree to work such hours, including such hours over 48 hours over any seven day period as is required of you to carry out your duties. You therefore give your consent to waive your right under the Working Time Regulations to have your working time limited to an average of 48 hours per week over the reference period as it may be defined from time to time. You further agree that, in the event that you wish to withdraw this consent, you will give to NHS Professionals three months’ written notice of the withdrawal of your consent. It is the duty of NHS Professionals to generally monitor your working hours including hours that you work for a person, firm, health service body or company other than NHS Professionals. You therefore agree that within two weeks of the day on which you sign these terms you will inform NHS Professionals of the following:

Any other work you carry out for any other person, firm, health service body or company, other than NHS Professionals

The days on which you carry out such work

The hours that you work for such person, firm, health service body or company and the times at which you carry out such work.

In addition, you agree that within two weeks of any change to work you carry
out for a person, firm, health service body or company, other than NHS Professionals, you will notify NHS Professionals of such change whether it involves a change in the total hours of such work, the times at which you perform such work or, indeed, where you commence work for a different person, firm, health service body or company. I have read and understood the terms set out above and agree to them. I also agree that the terms set out above form part of my overall terms and conditions of engagement with NHS Professionals.

Name (capitals):

________________________________________________

Department/Trust:

________________________________________________

Signed:

________________________________________________

Dated:

________________________________________________

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Substantive Registration/Appointment Form
Nursing & Midwifery Staff Group

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P46: Employee without a form P45
Section one

To be completed by the employee

Your employer will need this information if you don’t have a form P45 from your previous employer. Your employer may ask you to complete this form or provide the same information in another format. If you later receive your P45, hand it to your present employer. Use capital letters when completing this form.

Your details
National Insurance number
This is very important in getting your tax and benefits right

Date of birth DD MM YYYY

Title – enter MR, MRS, MISS, MS or other title

Address
House or flat number

Surname
Rest of address including house name or flat name

First name(s)

Postcode

Gender. Enter ‘X’ in the appropriate box
Male

Female

Your present circumstances

Student Loans (advanced in the UK)

Read all the following statements carefully and enter ‘X’
in the one box that applies to you.

If you left a course of UK Higher Education before last
6 April and received your first UK Student Loan
instalment on or after 1 September 1998 and you have
not fully repaid your Student Loan, enter ‘X’ in box D.
(Do not enter ‘X’ in box D if you are repaying your UK
Student Loan by agreement with the UK Student Loans
Company to make monthly payments through
D
your bank or building society account.)

A – This is my first job since last 6 April and
I have not been receiving taxable Jobseeker’s
Allowance, Employment and Support Allowance
or taxable Incapacity Benefit or a state or
A
occupational pension.
OR
B – This is now my only job, but since last 6 April
I have had another job, or have received
taxable Jobseeker’s Allowance,
Employment and Support Allowance or
taxable Incapacity Benefit. I do not receive
B
a state or occupational pension.
OR
C – I have another job or receive a state or
C
occupational pension.

Signature and date
I confirm that this information is correct
Signature

Date DD MM YYYY

2

P46

Page 1

0

HMRC 01/11

Section two

To be completed by the employer

Almost all employers must file employee starter information online at www.hmrc.gov.uk/online Guidance for employers who must file online can be found at www.businesslink.gov.uk/payingnewemployees Employers exempt from filing online should send this form to their HM Revenue & Customs office on the first payday. Guidance can be found in the E13 Employer Helpbook Day to day payroll.

Employee’s details
Date employment started DD MM YYYY

Works/payroll number and department or branch (if any)

Job title

Employer’s details
Employer PAYE reference
Office number Reference number

Address
Building number

/
Rest of address

Employer name

Postcode

Tax code used
If you do not know the tax code to use or the current National Insurance contributions (NICs) lower earnings limit, go to www.businesslink.gov.uk/payeratesandthresholds Enter ‘X’ in the appropriate box

Box A
Emergency code on a cumulative basis
Box B
Emergency code on a non-cumulative
Week 1/Month 1 basis
Box C
Code BR unless employee fails to
complete section one then code 0T
Week 1/Month 1 basis

Tax code used

A

If Week 1 or
Month 1 applies,
enter ‘X’ in this box

B

C

For employees who complete Box A or Box B starter notification is not needed until their earnings reach the NICs lower earnings limit.

Page 2

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