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Industry, Category & Role

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Category*

Role*

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Qualification & Skills

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Work History & Experience

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Documents

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Bank details ( for receiving payments)

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Account Name*

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Account Number*

I have a Limited Company

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Company Name*

Company registration number*

Company registration certificate*

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Your Personal Preferences & Terms
My Preferred Working Terms

My Rate

By Hourly Rate

/hr

By Shift/Day Rate

For

hr(s)

Travel Distance

I can travel

miles from my Location

Shift Duration (Hours)

Duration

Shift Starting Times (My preferrence)

Starting Times

Patient consultation Time

10 mins

15 mins

20 mins

Others

Telephone consultations

Do not prefer Telephone consultations

Minimum of 5 Minutes/ call

Minimum of 10 Minutes/ call

Minimum of 15 Minutes/ call

Other

Admin work

Perform reasonable admin work within my contracted hours

Only perform reasonable admin work within my contracted hours

Other

Private (Non-NHS) work

Do not prefer Non-NHS work during my contracted time

Can do limited Non-NHS work if performed within my contracted hours

Can do Non-NHS work for an extra Cost of

/hr

Home Visit Terms

I can do home visit if needed

YES

My rate for home visit is

/ visit

No of Visits I prefer to do

Additional Comments

Supervision

I do not prefer supervising

I am able to supervise trainees/ non GP-Collegues at a Flat rate of

/hr

Pension Contribution

I will claim superannuation

Yes

Cancellation Terms

Less than 7 days

Percent(%)

Between 7-14 days

Percent(%)

Greater than 14 days

Percent(%)

My Payment Terms

Default is 14 Days

from Job Date.

My payment Preference

BACS

Cheque

Other conditions ( please add any further personal conditions)

(1.)

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Industry, Category & Role

Contact Address

Qualification & Skills

Work History & Experience

Documents

Bank details ( for receiving payments)

Your Personal Preferences & Terms My Preferred Working Terms

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Your Personal Preferences & Terms
My Preferred Working Terms