FAST TRACK APPLICATION FOR TRUST EMPLOYEES TO JOIN THE TRUST

BANK
SECTION Candidate Information
Titl
First
Middle
Surna
Miss
Deborah
A
McMahon
e:
Name:
Initial:
me:
Home
83 Lightwoods Road, Bearwood, B67 5BH
Address:
Email
Deborah.mcmahon@heartofengland.nhs.uk
NI
Address
(work)
JK002833B
Number
marni300977@yahoo.co.uk (home)
Mobile
Date or
Assignme
07970062781
30/09/1977
20844299
No:
Birth:
nt No:
Nationalit
PIN No/Prof
Expiry
British
00C2113E
March 2017
y:
Registration
Date:
Leaving
Emergency
Present
Present
the Trust
Nurse
6
Job Title:
Band:
within 8
No
Practitioner
weeks
If yes, please state above what Band you will be
Retired:
No
returning as:
I understand that any wilful misstatement or omissions render me liable to
dismissal if engaged, or will enable the Trust to withdraw my application at
any time to appointment.
SECTION C: Bank details
Unless you inform us otherwise your weekly Bank earnings will be paid into
the same bank account as your substantive salary.
If you would like us to use a different account please contact us immediately
to confirm the details.
All eligible employed bank staff must be made Pensionable on every occasion they
work unless they have made it known that they do not wish to join the Scheme by
completing an opt-out form (SD502.) This can be found at
www.nhsbsa.nhs.uk/pensions
You are required to download your terms and conditions from the Temporary Staffing
website Clinical/Admin bank webpage http://sharepoint/clinicalbank via the Trusts
intranet home page.
By ticking this box you are confirming that you have read, understood and agree to the
terms and conditions
YesYYes
x
Candida
te
Date:
10/03/2016
Signatur
e:
We will accept this form being returned from a Trust email address in place of
a handwritten signature.
SECTION D: Line Manager Sign Off
I confirm that the above named is suitable to undertake Bank Shifts and holds a
substantive post within HEFT
We will accept this form being returned from a
Trust email address in place of a handwritten signature. Please complete all

other details.
Signatur
e:
Print
Name:

Date:
Job Title &
Band: