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Full Registration Form (Nurses)

Personal Details

Registration Details

Next of Kin Details

New Starter Form

This from is so that we (Smeaton Healthcare) can tell HMRC about you and help them to use the right tax code. Make sure you answer the questions correctly. If you do not, you may pay the wrong amount of tax or student loan deductions.

For further information, please visit

PAYE Information

Please ensure these details are correct, if payments are made in error due to incorrect details provided, please know that Smeaton Healthcare will do everything possible to recover any money, however this is not always possible.

About You

Work History

Please provide details of all employers, starting with your most recent.

For additional employment information, please use the additional space below, ensuring you provide full details. 



You must provide us with a minimum of 2 professional references in order to work with us. These references must be from your last 2 employers (Please contact us if unable to provide this) 


In order to speed up the recruitment process and prevent delays, please upload as many of the below files as you can. By uploading the files, you are consenting to Smeaton Healthcare storing these files on your electronic file.

Health Declaration

The following questions are to assist us in maintaining reasonable Health & Safety measures for our workers and to inform our clients to assist with ongoing Risk Assessments relating to workers being able to carry out their duties safely.

Criminal Convictions

I acknowledge that it is a requirement of my application and ongoing employment/engagement at Smeaton Healthcare to disclose any unspent criminal convictions as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

Because of the nature of the position you are seeking, it falls outside the scope of section 4.2 of the Rehabilitation of Offenders Act 1974 (Exemption Order 1975). As a result, applicants are not permitted to withhold information about convictions that, under different circumstances, would be considered 'spent' according to the provisions of the act. In the event of employment, failure to disclose such convictions may lead to dismissal or disciplinary action.


48 Hour Opt Out Agreement

I hereby declare that I have read and understood the 48-hour working time regulation as outlined in the working time regulations. I am aware that, as an agency worker at Smeaton Healthcare, I have the right to opt out of the 48-hour maximum working week limit.

I agree that by clicking yes below, I wish to work  more than an average of 48 hours a week. If I change my mind, I will give Smeaton Healthcare at least 28 days notice in writing to end this agreement.

DBS Declaration

I understand the nature and requirements of the role I am applying for and acknowledge that a Disclosure and Barring Service (DBS) check is  required as part of the recruitment process.

I hereby acknowledge and accept that I will be liable for covering the costs of my DBS if I resign or am dismissed from Smeaton Healthcare limited within 3 months of my start date. 

Data Protection & Confidentiality

I understand and acknowledge that Smeaton Healthcare is committed to complying with data protection laws, including but not limited to the General Data Protection Regulation (GDPR) and the Data Protection Act 2018. I consent to the processing of my personal data for the purpose of this application, including its storage. I understand that Smeaton Healthcare may have to share my information to other organisation such as, but not limited too, the DBS  or regulatory bodies such as NMC or CQC. They may have to share my data with customers in order to secure me work, or if I become a "temp to perm" in which case my information will be provider to my new employer who i would have been introduced to by Smeaton Healthcare. 

I understand and consent to the sharing of my professional profile, which will include (but not limited too) relevant qualifications & training, my experience, my photo, full name. I understand that my profile is shared when I am allocated and assignment (Shifts).

I recognise the sensitive nature of the information I may encounter during the course of my work at Smeaton Healthcare. I agree to maintain the highest level of confidentiality and discretion regarding all patient, employee, and organisational information. This includes, but is not limited to, Records, personal details, and any other proprietary or sensitive data.

Data Consent Declaration

I hereby provide my consent for Smeaton Healthcare to collect, process, and use my personal data for the sole purpose of facilitating job placements and meeting contractual obligations related to my engagement as an agency worker.

I understand that my personal information will be treated with confidentiality and security in accordance with applicable data protection laws. This consent is valid for the duration of my engagement and may be revoked by me in writing at any time.

Personal data may be stored within the following systems: 

  • Logezy 
  • Bright HR 
  • One Drive 
  • Microsoft Team 
  • Microsoft 365
  • Outlook 
  • Careberry 
  • Careskills 
  • Skillbox 
  • Bright Pay (Payroll)
  • Workplace (meta)


Codes of Conduct

NMC - The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates.

Skills for Care - Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England.

Agency Worker Handbook

Smeaton Healthcare’s Agency Worker Handbook
Link to Agency Worker Handbook: ENTER LINK

Temporary worker declaration


I acknowledge that any employer introduced to me, whether for a temporary or permanent position, holds a legally binding contract to remit charges in the event of my engagement in employment with them. I am fully aware that any effort to circumvent payment of these charges may lead to legal action.  Consequently, I affirm that I will neither apply for nor accept an offer of employment with any client introduced to me by Smeaton Healthcare Limited without prior permission. 

Equal Opportunities

Smeaton Healthcare is dedicated to maintaining a commitment to Equal Opportunities for all individuals seeking employment with us (whether temporary or permanent) We will consistently uphold this policy, continually reviewing all aspects of our recruitment processes to prevent any form of unlawful or undesirable discrimination. Our commitment extends to treating everyone equally, regardless of Sex, Sexual Orientation, Gender, Marital Status, Age, Disability, Colour, Race, Nationality, Ethnic or National Origin, Religion or Belief, Political Belief, and Membership or Non-Membership in a Trade Union.

Final Declaration

I hereby declare that all the information provided is true, complete, and accurate to the best of my knowledge. I understand that any false statements or omissions may result in my "Engagement of Temp Workers" being terminated.