Locum Registration Step 1 of 3 33% Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Title First Last Known As Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Nationality(Required) Date of Birth(Required) Month Day Year GPhC number(Required) Required DocumentsPassport(Required)Max. file size: 128 MB.Right to work(Required)Max. file size: 128 MB.Proof of address(Required)Max. file size: 128 MB.DBS(Required)Max. file size: 128 MB.Professional indemnity insurance(Required)Max. file size: 128 MB.EPS release 2 smart card(Required)Max. file size: 128 MB. Certificates CPPE declaration of competency for Discharge Medicines service (DMS) Level 2 safeguarding for children and vulnerable adults. Dementia friends NMS self accreditation form Repeat dispensing certificate Pharmacy first service Flu vaccine Covid vaccine Other choose all that applyOther Upload ProofCPPE declaration of competency for Discharge Medicines service (DMS)Max. file size: 128 MB.Level 2 safeguarding for children and vulnerable adults.Max. file size: 128 MB.Dementia friendsMax. file size: 128 MB.NMS self accreditation formMax. file size: 128 MB.Repeat dispensing certificateMax. file size: 128 MB.Pharmacy first serviceMax. file size: 128 MB.Flu vaccineMax. file size: 128 MB.Covid vaccineMax. file size: 128 MB.OtherMax. file size: 128 MB.TermsTerms & Conditions(Required) I agree to the terms & conditionsTerms and conditions for Locums DEFINITIONS In these terms:- "Assignment" means the period during which the Locum is supplied to the Client. "Locum" - Means a self employed Individual who is introduced by Top Locums to a client to render his/her services. "Client" means the firm, organisation or person from whom the Locum accepts an Assignment. "The Contract Date" means the date of the Assignment Letter "GPhC" means General Pharmaceutical Council Top Locums acts only as an introduction service to the Client and the Locum is deemed self employed and responsible for his or her own Income Tax and National Insurance contributions. Top Locums is not responsible for the payment of the Locum Fee, which is paid to the Locum directly by the client at the agreed rate and the Locum should ensure that they are aware of the client’s payment process including all expense policies – Top Locum will not be held responsible for any non or late payment, however will endeavor to mediate and resolve any payment queries where possible. Once the Locum has agreed to a placement with a Pharmacy it is that Locum’s responsibility to attend at the agreed date and time. Where due to unforeseen circumstances the Locum is late, the Locum must contact the pharmacy and Top Locum to inform them of their estimated time of arrival. In the event of the Locum unable to attend the placement due to illness absence, the Locum must contact Top Locum as soon as possible to avoid any client redress. There is no obligation for a Locum to accept any vacancy offered by Top Locum but upon acceptance of a vacancy by the Locum and confirmation by the Client a binding contract exists unless agreement to cancel the booking is given by the Client. Any breach of the agreement by the Client engaging Locum is not the responsibility of Top Locum, on whom Locum has no claim. Any claim for loss of earnings is to be made by the Locum directly with the Client. Locums must abide by the General Pharmaceutical Council (GPhC) Code of Practice, conduct, ethics and performance. The Locum must present themselves in a professional manner for the duration of each placement introduced by Top Locum. All information given to the Locum by Top Locum regarding vacancies is strictly confidential and is not to be passed on to any other Locum. Similarly, all information regarding any establishment at which the Locum has been engaged is also private and confidential. The Locum must inform Top Locum about any police or GPhC investigations which has or may have a bearing on their continuing registration with the GPhC and fitness to practice. The Locum will inform Top Locum of all occasions where self booking and/or Direct Booking between the Locum and the Client occurs in order to assist Top Locum in obtaining any charges owed to Top Locum by the Client. The Locum is required to inform Top Locum of any occasion where the Locum is employed directly by the Client within a period of 6 months following the last day they worked with the Client as a Locum. In the event of an offer of full time work with the client the Locum will notify Top Locum who will be entitled to charge the Customer the appropriate fee. By accepting these terms and conditions the Locum agrees that we may collect, store and use information about him in accordance with our privacy policy which is found on our Website or a copy is available upon request. The Locum acknowledges and agrees to be bound by the terms of our privacy policy. These terms and conditions shall be governed and interpreted in accordance with English Law and the English Courts shall have jurisdiction to resolve any dispute hereunderConsent(Required) I agree to the GDPR DeclarationGDPR Declaration As an essential part of its business, Top Locum is required to comply with the requirements of the UK Data Protection Act 2018 and any subsequent amendments to this legislation. During your engagement as a Locum Pharmacist, you will have access to and knowledge of customers and may have access to the personal details of business colleagues and contractors and their confidential information. Both during your engagement and after its termination, you have a professional duty to observe customer and colleague confidentiality and are prohibited from communicating or disclosing to any third party any customer or colleague information unless required by law or unless prior authorisation from the Company and / or the customer or colleague has been obtained. Any notes, records and other documents in your possession, are and shall remain the property of the company and should not be removed from the pharmacy premises without explicit written permission from the company's Pharmacy Superintendent’s Office. Guidance on standards you are expected to satisfy including duty of confidentiality and all relevant company policies will be available in the companies SOPs or via the companies Superintendent's office. You should be completing annual Data Protection and information Governance training offered by recognised Professional Bodies such as NHS Digital, GPhC, PSNI and Community Pharmacy Scotland. Any Locum disclosing confidential/patient records or information to any unauthorised person or persons will render you in breach of contract and subject to appropriate action, which may result in the cancellation of your contract and may be reported to the regulator. By agreeing to this declaration, you are confirming that you understand your responsibilities and will comply with all relevant company polices that support the business compliance with the current data protection act.Privacy Policy(Required) I agree to the privacy policySignature(Required)