Locum Direct - Locum Registration

Tel: 01275 462451
Fax: 01275 462935

To register as a Locum, please complete the form below.

Fields marked with a are mandatory

Locum Agreement Locum Direct Limited Locum Placement Terms and Conditions 1.This agreement is between Locum Direct Limited (hereinafter known as Locum Direct) and the Locum applicant. The pharmacy booking the Locum will, hereinafter, be known as the Client. 2.Any work introduced to you by Locum Direct will be on a self-employed basis and you are responsible for your own Tax and National Insurance Contributions. Locum Direct placement services are provided to you free of charge. 3.You must have a current registration with the Royal Pharmaceutical Society of Great Britain and be a permanent resident of the United Kingdom or hold a current work permit. 4.You will provide two appropriate references, which will be taken up prior to any engagement. 5.Agreements to undertake locum work are binding both professionally and legally and you must honour these agreements. You are requested to act professionally at all times and dress appropriately, arriving and leaving in accordance with the agreed hours. 6.If you are unable to attend the booking, e.g. in case of sickness, Locum Direct is to be informed immediately. 7.You are under no obligation to accept a Locum placement, however, when you have agreed to accept a booking, and Locum Direct have provided confirmation, this represents a contractual commitment. 8.Locum Direct is not responsible for the payment of your fee which is payable directly by the Client. Locum Direct will not accept any liability in relation to unpaid fees. 9.Any breach of the agreement by the Client who engages you is not the responsibility of Locum Direct. Any claim for loss of earnings is to be made directly to the Client. 10.If you are approached directly by the Client, within twelve months of the previous engagement, to undertake a similar booking you agree to refer the Client to Locum Direct. In the event that a referral is not made you will be responsible for payment of our fee. 11.Any information that Locum Direct may provide concerning vacancies is strictly confidential and any information regarding the Client where you are engaged should be treated as private and confidential. 12.There should be no restriction in your passport in relation to your ability to work in the UK. 13.You should not make direct contact with the Client prior to engagement without the consent of Locum Direct. 14.Locum Direct must receive a signed copy of these terms prior to completion of your registration.

To complete the registration procedure please tick the box below if you have read and agree to be bound by the terms and conditions outlined above.

I confirm that I understand the terms of this agreement and I agree to be bound by the conditions herein.

Title*
Forename(s)*
Surname*
DOB*		/ /
Nationality*
Address*
Town*
County*
Post Code*
Home Tel*
Mobile Tel
Work Tel
Email Address*
RPSGB Reg No.*
Date of Reg*		/ /
Work Permit No.
National Insurance No.*
Do you hold professional indemnity cover?*		Yes No
Brief History of Experience and Computer Systems* Submit CV to admin@locum-direct.com
Do you have Medicines Use Review?		Yes No
Do you have Repeat Dispensing?		Yes No
Do you have a car?		Yes No
How far are you willing to travel?		Up to 25 miles Over 25 miles
Where did you hear about us?*
Friends Name:
Name & Address of 1st Reference*		Name & Address of 2nd Reference*
Postcode*		Postcode*
Telephone No*		Telephone No*