PLEASE DO NOT TYPE

MUST BE HANDWRITTEN
Application pack
DRC Group is one of the country’s leading providers of medical locums to the
National Health Service and the private medical sector.
We provide rewarding careers for our doctors with a material investment in continuous
training and development for our staff.

Being a member of DRC Group makes you a vital component in the tri-partite
relationship between our clients, our doctors and our teams.
 Application form
Please complete form in block capitals; it is important that you use black ink.

1 Personal details 3 Contact details

Title : Home address :

Dr Mr Mrs Miss Ms Other :

First name :

Surname : Post code :

Gender : Daytime telephone no :

Male Female

Date of Birth : Evening telephone no :

Marital status : Mobile :

Do you hold a current driving license? Email address :

(if so please forward a copy)
Yes No

Please provide two recent photographs of yourself, signed on the back by you Preferred method of contact :
and two forms of identification (e.g household bill showing address, passport,
etc.) Daytime telephone no Evening telephone no

National insurance number : Mobile Email

4 Professional body registration

Grade :
Type of membership :

Specialty : Membership no :

Renewal date :

2 Nationality Are you currently under investigation by your professional body or any
other organisation?
Yes No
British / EC National : Passport number :
Have you ever been investigated by your professional body or any
Yes No other organisation?
Yes No

Permanent resident status : Issued at : If yes, please give details below

Yes No

Holder of work permit : Expiry date :

Yes No
It is the responsibility of the applicant to inform DRC Group of any changes or
restrictions to their registration or license to practice.
5 GMC’s performance Are you registered with a responsible officer?
Yes No
monitoring process Name of responsible offer :

I confirm I am aware of the GMC’s performance monitoring process. Jane Mamelok

Designated body name :

Signature
Health Education North West

Address :

Three Piccadilly Place

Have you made formal arrangements to be appraised regularly by an
appropriately trained medical practitioner entered on the specialist
register?
Yes No Manchester

Name and contact details of a registered medical practitioner who has Post code :
agreed to act as your appraiser :
M1 3BN
Name :

6 Professional indemnity
Mr David Van Dallen (Programme Director) North West Deanery

Current address :
insurance
Do you have professional indemnity insurance? If yes, a legible copy of
the certificate must be supplied.
Yes No

Name of insurer :
Post code :
Medical Defence Shield
Policy no :
Daytime telephone no :
150401113

Expiry date :
Mobile : 14 04 2018

GMC number :
7 International workers
In addition to completing a CRB application form, you will need to
provide evidence of police clearance from your country of origin. If
The date when the last appraisal was carried out and the date when
you have entered this country within the last six months. This police
the next one is due :
clearance cannot be more than three months old from the date of this
application form.
Date of last appraisal* : Date of next appraisal :
International English Language Testing System (IELTS)
Please tick the box to confirm that you have passed each of the four academic
08 2017 modules of the IELTS test as administered by the British Council and have
provided the original IELTS certificate with this application.

The date of last successful revalidation and the due date of the next
revalidation :

Date of last revalidation : Date of next revalidation :

8 Specialty
Please provide details of specific specialty experience you have in the
04 10 2016 03 10 2021 additional info section overleaf.

*Please supply a copy of your last appraisal summary including your Personal Are you entered on the specialist register? Yes No
Development Plan.
Do you hold section 12 if appropriate? Yes No

Do you hold section 22 if appropriate? Yes No

Do you hold approved Clinician status? Yes No

9 Employment history
Please provide details of your current work placements. 3 years of referee details (please include another if necessary).

Name : Name :

ST3 Breast Surgery Specialty Doctor Colorectal Surgery

Address : Address :

Blackpool Victoria Hospital, Blackpool York Hospital, York

Post code : Post code :

FY3 8NR YO31 8HE

Start date : End date : Start date : End date :

03 08 2017 02 04 2018 01 11 2016 02 08 2017

Daytime telephone no : Daytime telephone no :

01253300000 01904631313

Evening telephone no : Evening telephone no :

Mobile : Mobile :

10 Professional referees
First referee : Second referee :

Mr Mujahid Khurshid Mr David Archampong

Current address : Current address :

Blackpool Victoria Hospital, Blackpool Blackpool Victoria Hospital, Blackpool

Post code : Post code :

FY3 8NR FY3 8NR

Telephone no : Telephone no :

Fax no : Fax no :

Email : Email :

mr.khurshid@bfwhospitals.nhs.uk David.archampong@bfwhospitals.nhs.uk
11 Next of kin/Emergency
contact details
Title : Daytime telephone no :

Dr Mr Mrs Miss Ms Other :

First name : Evening telephone no :

Samia
Surname : Mobile :

Siddiqui 07828726619
Home address : Relationship :

56 Marsh Road, Thornton-Cleveleys Wife

Post code :

FY5 2SF

12 Education and training

Please supply documentary evidence

University / Institution/Training Qualification Date of graduation

Punjab University Lahore Pakistan MBBS 2000

Royal College of Surgeons of Edinburgh MRCS

2007

Hull York Medical School/University of York MD

2017
13 Declaration of Criminal record
As a healthcare worker, you must undergo an enhanced DBS disclosure (PVG
check if working in Scotland).
Rehabilitation of Offenders Act (exceptions) Order 1975 (as
amended in 2013
Do you have any convictions, cautions, reprimands or final warnings that are not
“protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions)
Order 1975 (as amended in 2013)?
The amendments to the Exceptions Order 1975 (2013) provide that certain
spent convictions and cautions are ‘protected’ and are not subject to disclosure
to employers , and cannot be taken into account. Applicants are NOT entitled
to withhold information about convictions which for purposes are deemed
spent but not protected under the provisions of the Act. In the event of
employment, any failure to disclose such convictions will result in your removal
from the register. Any information you may give will, of course, remain strictly
confidential. DRC Group may contact you for permissions to disclose such
details if relevant to the position you are applying for.
Guidance and criteria on the filtering of these cautions and convictions can be
found on the Disclosure and Barring Service website :
http://www.legislation.gov.uk/uksi/2013/1198/pdfs/uksi_20131198_en.pdf
15 Working time regulations
The Working Times regulations 1998 (”The Regulations”) require DRC Group to
limit your average weekly working time to 48 hours, unless you agree with DRC
Group that the limit shall not apply to you.
DRC Group wishes to have an agreement with you whereby it proposes an
agreement (which will apply until terminated notice) on the basis that:
1 The 48 hour limit on average weekly time shall not apply to you.
2 You may terminate the agreement (so that the 48 hour time limit would
apply to you) by giving a nominated person at DRC Group your 4 weeks
written notice.
Under the Regulations, DRC Group must keep records relating to your working
time. This is the case whether or not you reach an agreement with DRC Group
about waiving working time limits.
If you accept DRC Group proposals, please sign below. This document will then
be the record of the agreement. You may choose to sign this proposal and DRC
Group will not subject you to any detriment if you do not sign it or exercise
your right to terminate it.
Signature

Have you ever been DBS checked? Yes No Date

If so, by whom
06 02
03 2018

Date you were last DBS checked?

03 2017
16 Declarations of consent
08
I declare that all the information I have given in this application form is true
Do you have any spent or unspent convictions/cautions/warnings/ and is not in any way intended to mislead. I acknowledge that by completing
reprimands? If yes, please complete section 14 Yes No this application, I am aware and agree to the disclosure of personal information
to DRC Group and all affiliated companies. In addition I agree that DRC Group
and affiliates may forward to authorised recipients, and in strictest confidence,
Are you a member of DBS update service? Yes No confidential details held on file in relation to my Application and Employment.
I agree that if I have given false or misleading information or do not give
Issue number : relevant information now or in the future, this may result in termination of an
assignment without notice.
001583096930 (certificate number)
I duly authorise DRC Group or its agents to verify the information I have
Give permission for DRC Group to update my DBS annually or when provided, as required, in the common interests of patient safety. I acknowledge
required? that I have been given a copy of the Terms and Conditions and access to
Yes No the Locum Handbook by DRC Group and I will abide by those Terms and
Conditions.
Are you a member of the PVG scheme? Yes No
The information I have given is to the best of my knowledge, a true and
PVG screen ID complete account of my medical history. I give permission to DRC Group Ltd
to have access to my medical records pertinent to my immunisation and blood
test history. I duly authorise DRC Group or its agents to verify the information I
have provided, as required, in the common interests of patient safety.

I confirm my consent for DRC Group to obtain an enhanced DBS disclosure. In

order to process your DBS application, we may attempt to verify your identity

14 Details of any convictions/

using a third party (Experian).The agency will check the details you supply
against any particulars on any database (public or otherwise) to which they
have access. A record of the search will be retained but will not be visible to
cautions/warnings/ other parties or affect your credit record. I understand and agree to DRC Group
obtaining copies of employment references to be disclosed to clients for the

reprimands purposes of finding me assignments.

I furthermore confirm my consent that DRC Group may be required to share

Please provide details of any spent or unspent convictions/cautions/ my information with third parties for audit purposes. I understand that this will
warnings/reprimands only be done when required and that DRC Group ensures that the protection
afforded under the Data Protection Act remains.

NA

Signature

Date
06 03
02 2018
Terms & conditions
1. This Agreement between the Candidate and DRC Locums (each a “Party” and together “the Parties”) as defined in these terms
and conditions (“these Conditions”) shall consist of the information set out in the Booking Confirmation and these Conditions.
Acceptance of these Conditions is assumed when the Candidate completes and returns a completed Application Form.
2 Interpretation
2.1 In these Conditions the following words shall have the following meanings:-
Application Form : DRC Locums’s application form concerning particulars of the Candidate; practice and rules concerning the performance by the Candidate of the Candidate Services in the UK and at the Client Site;
Assignment : the assignment of work in respect of which Candidate Services are to be supplied and set out in the Booking
Confirmation;
Booking Confirmation : written confirmation from DRC Locums giving particulars of the Assignment;
Business Day : 9 a.m. to 5.30 p.m. Monday to Friday excluding public holidays;
Client : the health trust or other business or company client to whom DRC Locums provides Candidate Services, which shall
include all associated departments, hospitals, and sites of the Client;
Conduct Regulations : the Conduct of Employment Agencies and Employment Business Regulations 2003 as amended
and “employment” and “work” shall have the same meaning as in the Conduct Regulations;
Connected Person : a person associated or connected to a Company Candidate as defined in the Conduct Regulations who
is intended at the date of the Application Form to be supplied by the Company Candidate to perform the work;
Contract Period : the period of the supply by DRC Locums of Candidate Services to the Client which is set out in the
Booking Confirmation or which commences on the Start Date and finishes on the Termination Date or any period in which the
supply is made or is deemed to be made in accordance with these Conditions, whichever is applicable;
DRC Locums : DRC Locums is part of DRC Holdings Limited registered in England No. 06550485. Registered Office : Partis
House, Davy Avenue, Knowlhill, Milton Keynes, MK5 8HJ; Confirmation shall state the hours of work, any night work and rest periods and breaks. The Candidate shall take the rest periods
Indemnify : indemnify and keep indemnified at all times against all claims, demands, liabilities, damages, costs and expenses
including special, indirect and consequential loss and “Indemnified”, “Indemnity”, etc. shall be construed accordingly; Confirmation.
Candidate : the individual or company named in the Application Form and Company Candidate shall be construed accordingly;
Candidate Services : the medical, dental or other health professional services set out in the Booking Confirmation to be
supplied from time to time by DRC Locums to the Client using the Candidate; Services.
Site: the location at which Candidate Services are to be supplied which shall include any other location where the Candidate
Services are provided;
Start Date : the start date set out in the Booking Confirmation for the supply by DRC Locums of the Candidate Services; Services.
Termination Date : the date on which the Candidate Services are contracted to end or terminate in accordance with these
Conditions or set out in the Booking Confirmation, whichever is applicable;
The Working Time Regulations : the Working Time Regulations 1998 as amended;
2.2 In this Agreement, the headings of the Conditions are for ease of reference only and shall not be taken into account in the
construction or interpretation of this Agreement and words denoting any gender include all genders where the context so admits.
3 Status of the Parties and of this Agreement
3.1 This Agreement is a contract for services between DRC Locums and the Candidate who is self-employed or a company, for the
onward supply to one or more Clients of Candidate Services to be performed by the Candidate in accordance with one or more
Assignments and:-
3.1.1
3.1.2
this Agreement shall not give rise to any contract of service between DRC Locums and the Candidate; and
no contract for services shall exist between DRC Locums and the Candidate after or between Assignments, but this shall be
without prejudice to Condition 14.4 which shall at all times continue in force;
3.1.3 the Candidate shall be entitled after or between Assignments (or during the same period as an Assignment, if another concurrent
engagement does not interfere with the Assignment,) to supply work or services similar to the Candidate Services whether
directly or indirectly via any other employment agency or employment business to any person but this shall be without prejudice
to Condition 14.4 which shall at all times continue in force.
3.1.4 Mutuality of Obligations:
3.1.4.1 DRC Locums is not obliged under this Agreement or otherwise to provide work for the Candidate.
3.1.4.2 The only work for the Candidate and the only obligation on the Candidate to perform services arising out of this Agreement is
each Assignment.
3.1.4.3 The Candidate shall be entitled in accordance with Condition 5.4 to notify DRC Locums prior to the Start Date of any Assignment
that it is unwilling to undertake that Assignment.
3.1.4.4 DRC Locums is not obliged to make any payment to the Candidate and no rights under the Working Time Regulations accrue to the
Candidate between Assignments.
3.2 DRC Locums is an employment business as defined by the Conduct Regulations.
3.3 The Employment Agencies Act 1973 prohibits DRC Locums from charging a fee to the Candidate in respect of its work-finding
services.
3.4 Except as provided in clause 3.5, the Candidate shall account to and pay to the appropriate revenue authority all proper tax and
national insurance in respect of each payment made by DRC Locums to the Candidate under this Agreement and DRC Locums
shall not make statutory deductions for PAYE and NICs in respect of the Candidate.
3.5 If in the case of a Candidate which is not a Company Candidate, DRC Locums is obliged to make statutory deductions for PAYE
and NICs, Conditions 3.4 and 8.6 shall not apply and DRC Locums shall make such deductions from any payment due to the
Candidate and pay them to the appropriate revenue authority and the Candidate Indemnifies DRC Locums against any error in
such deductions which arises from incorrect information given by the Candidate.
3.6 This Agreement applies to all Candidate Services provided by DRC Locums to Clients using the services of the Candidate after the
date the Candidate delivers to DRC Locums the Application Form.
3.7 DRC Locums will endeavour to procure Assignments for the Candidate to work but shall incur no liability to the Candidate for any
failure to do so, howsoever arising.
4 DRC Locums Obligations
4.1 Prior to any work-finding services being provided to the Candidate and within 5 Business Days after any agreed variation, DRC
Locums and the Candidate will agree and DRC Locums shall set out in one document to the Candidate:-
4.1.1 the type of work DRC Locums will find or seek to find for the Candidate;
4.1.2
4.1.3
that DRC Locums contracts with the Candidate on a contract for services and the terms of that contract;
that DRC Locums will pay the Candidate in respect of work done by him or it whether or not DRC Locums is paid by the Client in
respect of that work;
4.1.4 the length of notice of termination which the Candidate will be required to give DRC Locums, and which he will be entitled to
receive from DRC Locums, in respect of particular Assignments with Clients;
4.1.5 the rate of remuneration payable to the Candidate; or
4.1.6 the minimum rate of remuneration DRC Locums reasonably expects to achieve for the Candidate;
4.1.7 details of the intervals at which remuneration will be paid; and
4.1.8 details of any entitlement to annual holidays and to payment in respect of such holidays.
4.2 Prior to DRC Locums introducing the Candidate to the Client, DRC Locums shall:
4.2.1 take all reasonable steps to ensure that the Candidate and the Client are each aware of any requirements imposed by law, or by
any professional body, which must be satisfied by the Client or the Candidate to enable the Candidate to work for the Client in the
position which the Client seeks to fill; and
4.2.2 make all reasonable enquiries to ensure that it would not be detrimental to the interests of the Candidate or the Client for the
Candidate to work for the Client in the position which the Client seeks to fill.
4.3 At the same time as DRC Locums offers a position with a Client to the Candidate, unless DRC Locums has already done so, DRC
Locums shall notify the Candidate either orally or in writing, which shall include for the purposes of this Condition electronic
means, and written notice shall be given not later than three Business Days after any only oral notice, of:-
4.3.1 the identity of the Client and, if applicable, the nature of the Client’s business;
4.3.2 the date on which the Client requires a Candidate to commence work and the duration, or likely duration, of the Assignment;
4.3.3 the position which the Client seeks to fill, including the type of work a Candidate in that position would be required to do, the
location at which and the hours during which he or it would be required to work;
4.3.4 any risks to health or safety known to the Client and what steps the Client has taken to prevent or control such risks;
4.3.5 the experience, training, qualifications and any authorisation which the Client considers are necessary, or which are required by
law, or by any professional body, for a Candidate to possess in order to work in the position;
4.3.6 any expenses payable by (or, exceptionally, to) the Candidate; and
4.3.7 if DRC Locums has not yet notified the Candidate of the rate of remuneration payable to the Candidate in accordance with
Condition 4.1.5, that rate.
5 Candidate Obligations
5.1 The Candidate shall complete the Application Form in full and warrants to DRC Locums that all particulars are true and complete
and in full force and effect and that there is no other fact or record such as professional misconduct or personal health which
would affect consideration by any reasonable prospective employer of any application for employment from the Candidate:
5.1.1 at the date of the Candidate delivering it to DRC Locums; and
5.1.2 at all times throughout the Contract Period.
5.2 With the completed Application Form, the Candidate shall deliver to DRC Locums originals or true and complete copies (if
requested by DRC Locums, certified by a solicitor or notary) of evidence in respect of the Candidate of the following (“the
Candidate Documentation”);
5.2.1 identity;
5.2.2 the right to work in the United Kingdom where applicable;
5.2.3 any required medical, dental or other health professional qualifications in respect of the agreed type of work referred to in
Condition 4.1.1;
5.2.4 the experience, training and any authorisation to work in the agreed type of work referred to in Condition 4.1.1;
5.2.5 General medical Council or other equivalent certification;
5.2.6 hepatitis B certification;
5.2.7 any criminal record certificate required by DRC Locums; and
5.2.8 two references from persons who are not relatives of the Candidate and who have agreed that their references may be disclosed
to the Client.
5.3 The Candidate warrants that the Candidate Documentation is true, complete and in full force and effect:-
5.3.1 at the date of the Candidate delivering them to DRC Locums; and
5.3.2 at all times throughout the Contract Period.
5.4 Prior to the Start Date the Candidate shall notify DRC Locums whether or not the Candidate is willing to supply the Candidate
Services in the position which the Client seeks to fill and that notice shall be irrevocable.
6 Conduct of the Candidate Services and Indemnity
6.1 If the Candidate has notified DRC Locums that it is willing to supply the Candidate Services in accordance with Condition 5.4, upon
DRC Locums contracting with a Client for the supply of Candidate Services using the Candidate, the Candidate agrees to perform
the Candidate Services and Indemnifies DRC Locums in respect of the Candidate’s failure to do so.
6.2 DRC Locums:
6.2.1 is not the issuer of Candidate Documentation and relies upon the Candidate’s warranty of its completeness and accuracy and the
Candidate’s other information as to his qualifications, training, experience or authorisation to perform the Candidate Services;
6.2.2 is not medically qualified; and
6.2.3 does not exercise control over the Client;
6.2.4 does not control, direct or supervise the Candidate in the performance of Candidate Services.
6.3 The Candidate shall at the date of the introduction of the Candidate to the Client and at all times throughout the Contract
Period:-
6.3.1 perform Candidate Services to the best of his or its ability in a professional manner using the highest possible care and skill and
standards commensurate with the qualifications and experience evidenced by the Candidate Documentation and, subject thereto,
do so in accordance with his own initiative and his own discretion;
6.3.2 comply with all applicable work permit, immigration, professional, health and safety and other laws and regulations, codes of
6.3.3 make all proper enquiries to ensure that he is suitably qualified and experienced (including any requirements as to his own health)
to perform the Candidate Services;
6.3.4 make all reasonable enquiries to ensure that the Client and any agent, employee and Candidate of the Client who has
responsibility for or acts in conjunction with the performance of the Candidate Services is suitably qualified and experienced to do
so;
6.3.5 ensure or verify that the Client insures for the benefit of DRC Locums, the Candidate, the Client, and the Client’s employees,
agents, Candidates, patients, clients, customers, guests, and visitors, all risks (including personal injury and other loss and
damage to the Candidate) associated with the performance of the Candidate Services, attendance by the Candidate at the Site
and travelling to and from the Site, and the Candidate acknowledges that DRC Locums does not insure these risks (and those
beneficiaries shall be entitled to enforce this Condition and Condition 16.4 shall not apply to this Condition 6.3.5);
6.3.6 subject to the Candidate’s overriding duty set out in Condition 6.3.1:
6.3.6.1 comply with the reasonable instructions of the Client which do not conflict with that duty; and
6.3.6.2 comply with DRC Locums’s directions concerning the continuation of the supply of Candidate Services or its termination or any
amendment to the Candidate Services and the Candidate Indemnifies DRC Locums in respect of any failure to do so; and
6.3.7 not to do anything during the period of an Assignment which is likely to bring the Client or DRC Locums into disrepute.
6.4 Subject to Condition 10 in relation to a Company Candidate, DRC Locums shall comply with the Working Times Regulations where
applicable and shall not agree with the Client a Booking Confirmation which does not so comply and in particular the Booking
and breaks, and shall inform DRC Locums of any request by the Client to work outside the particulars specified in the Booking
6.5 The Candidate Indemnifies DRC Locums in respect of any breach of Condition 6 and because of the matters set out in this
Condition, DRC Locums excludes all liability to the Candidate in respect of or arising out of the acts or omissions of the Client and
the Client’s employees, agents, Candidates, patients, clients, customers, guests, and visitors and the performance of Candidate
6.6 The Candidate Indemnifies DRC Locums from any claim brought against DRC Locums by the Client or by any other person in
respect of any personal injury or damage sustained by the Client or the Client’s employees, agents, Candidates, patients, clients,
customers, guests, and visitors or by any other person arising out of or in connection with the performance of the Candidate
7 Application of the Conduct Regulations to a Company Candidate
7.1 If the Candidate is a Company Candidate:
7.1.1 Condition 4.1.8 shall read “details of any period of absence to which the Candidate is entitled and of any entitlement to payment
in respect of the same”;
7.1.1 in Conditions 4.2.1 and 4.2.2 and 4.3.5 for the word “Candidate” there shall be substituted the words “the Candidate and the
Connected Person”;
7.1.3 in Conditions 5.2, for the words “in respect of the Candidate” there shall be substituted the words “in respect of the Candidate
and the Connected Person”;
8 Payment
8.1 Throughout the Contract Period the Candidate shall deliver to or procure that the Client delivers to DRC Locums at the end of
each calendar week or of the Assignment if earlier a timesheet completed by the Candidate in respect of the Candidate Services
which has been signed by the Client. In particular the Candidate must enter on the timesheet the number of hours worked by the
Candidate since the previous timesheet or the Start Date whichever is the later.
8.2 The Candidate warrants that the particulars on the timesheet, including any expenses or disbursements which the Client has
agreed with DRC Locums to pay or reimburse, is true and complete.
8.3 DRC Locums shall not be obliged to make any payment to the Candidate in the absence of a timesheet duly completed by the
Candidate.
8.4 DRC Locums shall pay the Candidate at the rate of remuneration and on the dates which have been agreed with the Candidate at
or before the Start Date whether or not DRC Locums has received payment from the Client and after receipt by DRC Locums of:-
8.4.1 a duly completed timesheet and, if it has not been signed by the Client, DRC Locums has satisfied itself that the Candidate has
worked for the particular period in question; and
8.4.2 an invoice from the Candidate containing all particulars reasonably demanded by DRC Locums.
8.5 Subject to any statutory entitlement, the Candidate is not entitled to receive payment from DRC Locums between Assignments in
respect of holidays, illness or absence for any other reason.
8.6 The Candidate undertakes to account to and make all proper deductions and payments in respect of all proper tax and national
insurance to the revenue authorities in the UK when due and Indemnifies DRC Locums against any demand, or claim for interest or
penalties made by any revenue authority arising out of or in connection with the performance of the Candidate Services whether
by the Candidate or any Connected Person.
8.7 The Candidate shall deliver to DRC Locums with the Application Form and on demand from DRC Locums a letter from accountants
who are and will continue to be instructed by the Candidate throughout the period of this Agreement in the matter of properly
accounting to and making all proper deductions and payments in respect of tax and national insurance to the revenue authorities
in the UK, which confirms that they are instructed to do so.
8.8 Where the supply of services by the Candidate to DRC Locums is or becomes subject to VAT, DRC Locums shall not be obliged to
make payment until receipt of a valid VAT invoice and the Candidate agrees to deliver to DRC Locums on demand a VAT invoice in
respect of the supply.
8.9 If DRC Locums is satisfied that it has made an incorrect or over-payment to the Candidate, the Candidate agrees to repay the
amount incorrectly or over-paid within 10 Business Days of a demand by DRC Locums and shall not be entitled to withhold from
DRC Locums any amount due to DRC Locums on the ground of any claim for damage or loss or alleged breach of contract and
shall not be entitled to make any deduction from the amount due or exercise any right of set-off and shall pay interest at the rate
of 5% above the base rate of the Bank of England calculated from the date when payment becomes due or the demand is made
whichever is earlier up to and including the actual payment including all accrued interest whether before or after judgment.
9 Exclusion of the Maximum Weekly Working Time Under the Working Time
Regulations
9.1 Each Candidate who is not a Company Candidate agrees that his working time may exceed the maximum weekly working time
under the Working Time Regulations.
9.2 The Candidate’s agreement in Condition 9.1 applies indefinitely during the period of this Agreement, until three month’s notice
from the Candidate given in accordance with Condition 15.
10 Application of the Working Time Regulations to a Company Candidate
10.1 DRC Locums is not obliged to provide annual leave, rest periods, rest days or a maximum working week or any other right granted
or regulated by the Working Time Regulations to a Company Candidate and does not do so.
11 Holiday Entitlement
11.1 Under the Working Time Regulations the Candidate who is not a Company Candidate is entitled to 20 Business Days annual leave
per year continuously worked on Assignment under this Agreement. DRC Locums’s leave year (“the Leave Year”) commences on
the 1st day of April.
11.2 The right to paid annual leave accrues at the rate of 1.66 days per month continuously worked on Assignment during the Leave
Year and during the first Leave Year the Candidate may not take more than the monthly rate accrued to the date of start of
leave. In this Condition 11, “continuously” shall mean that the Candidate has worked continuously throughout each Business Day
during the period, subject to statutory rest periods and rest days, and annual leave shall accrue in proportion to any part of each
Business Day worked by the Candidate in accordance with the Booking Confirmation.
11.3 Annual leave which is not taken by the Candidate in any Leave Year may not be carried over to the next leave year.
11.4 Payment in lieu of annual leave cannot be paid during the course of this Agreement.
11.5 Annual leave shall not accrue during any period when there is not in existence a contract for services between DRC Locums and
the Candidate, namely in between Assignments.
11.6 The Candidate shall give to DRC Locums notice of a request to take leave which is at least twice the period of leave which the
Candidate requests to take. DRC Locums can give a counter-notice of at least the same number of days as the period of leave
requested, requiring that the leave be postponed or reduced.
12 Restrictive Covenants
12.1 The Candidate and the Connected Person agree that DRC Locums is the effective cause of introduction of the Candidate and the
Connected Person to the Client.
12.2 Unless at the date of DRC Locums’s introduction of the Candidate to the Client (which shall be deemed to be the date that DRC
Locums gives any oral or written information to the Client concerning the availability of the Candidate to perform the Candidate
Services), the Candidate notifies DRC Locums that DRC Locums is not the effective cause of introduction of the Candidate and
the Connected Person to the Client and produces evidence to DRC Locums proving that another person is the effective cause of
introduction, DRC Locums shall be deemed to be the effective cause of introduction of the Candidate and the Connected Person to
the Client for each Restrictive Period.
12.3 DRC Locums shall not be obliged, by reason of being or being deemed to be the effective cause of introduction to a Client, to make
any payment to the Candidate or the Connected Person or perform or undertake any obligation to the Candidate or the Connected
Person in respect of services performed by the Candidate or the Connected Person unless DRC Locums has agreed in advance of
such services to do so.
12.4 In the event that DRC Locums is or is deemed under these Conditions to be the effective cause of introduction of the Candidate,
“the Client” in this Condition shall also include any person to whom the Candidate or the Connected Person is introduced during or
arising out of or in connection with the performance of the Candidate Services such as (without limiting the foregoing) any other
Client Site, department, hospital, trust, partnership, company or business.
12.5 The Candidate Indemnifies DRC Locums in respect of any breach of this Condition and Condition 13, including any loss of income
of DRC Locums from the Client which DRC Locums would have received but for a breach of those Conditions.
13 Intellectual Property and Confidential Information
13.1 The Candidate hereby assigns to the Client ownership of all intellectual property created in the course of the performance by
the Candidate of the Candidate Services. The Candidate shall from time to time when requested by DRC Locums execute all such
documents and do all such acts as DRC Locums may require in order to give effect to or further protect that ownership.
DRC Group is part of DRC Holdings
drc locums Limited which is registered in
England no. 06550485. 12
13.2 This Agreement is confidential to the Parties and neither Party shall disclose it to any other person including the Client, apart
from that Party’s professional advisors or as may be required by law.
13.3 The Candidate permits DRC Locums to disclose to Clients and to any debt collection, credit or security agency any information
relating to this Agreement including the Candidate’s and, in the case of a Company Candidate, its Connected Person’s particulars.
13.4 The Candidate shall not disclose nor use in the Candidate’s own interest or any other person’s interest any confidential information
relating to the Client’s or DRC Locums’s business or financial affairs nor assist or permit anyone else to do so.

14 Termination

14.1 Subject to any longer period specified in accordance with Condition 4.1.4, DRC Locums may terminate the Candidate Services of a
Candidate in respect of an Assignment at any time forthwith without prior notice or liability.
14.2 Subject to any different period specified in accordance with Condition 4.1.4, the Candidate may terminate his or its Candidate
Services in respect of an Assignment by not less than one Business Day’s notice during the first week of an Assignment and
thereafter by not less than one week’s notice to DRC Locums.
14.3 Subject to Conditions 14.1 and 14.2, either Party may terminate this Agreement forthwith by notice to the other Party.
14.4 Neither termination of this Agreement nor any period of time between Assignments or after any Assignment shall affect:-
14.4.1 any accrued rights or liabilities of either Party; or
14.4.2 the coming into or continuance in force of any provision of this Agreement which is expressly or by implication intended to come
into or continue in force on or after such termination or between Assignments or at any time after any Assignment, including
Conditions 9, 12, 13, and 14.
14.5 On termination of this Agreement:-
14.5.1 DRC Locums shall not be obliged to supply or continue to supply any Candidate Services in respect of the Candidate to the Client;
and
14.5.2 the Candidate and, in the case of a Company Candidate, its Connected Person shall cease to perform Candidate Services for the
Client under this Agreement.

15 Notices

15.1 Notices under or arising out of this Agreement shall be in writing and shall either be delivered personally or sent by first class
prepaid post and shall be deemed duly served:
15.1.1 if delivered personally during a Business Day, at the time of delivery and if delivered outside a Business Day, on the next following
Business Day;
15.1.2 if sent by first class prepaid post, on the second Business Day after the date of dispatch.
15.2 Each notice shall be addressed to the respective Party’s address set out in this Agreement or the Application Form or any new
address of such Party in England and Wales which that Party shall have previously notified to the other Party in accordance with
this Condition.
15.3 Such address shall also be the address for service for the respective Party of any proceedings in relation to or arising out of this
Agreement.

16 General

16.1 If any provision or any part of a provision of this Agreement is prohibited by law or judged by a court to be unlawful, void or
unenforceable, that provision or part shall, to the extent required, be severed from this Agreement and rendered ineffective as far
as possible without modifying the remaining provisions of this Agreement, and shall not in any way affect any other circumstances
of or the validity or enforcement of the other provisions of this Agreement which are not affected by that provision.
16.2 Neither Party shall by mere lapse of time without giving notice or taking other action hereunder be deemed to have waived any
breach by the other Party of any of the provisions of this Agreement. The waiver by either Party of a particular breach of this
Agreement by the other Party shall not be construed as, or constitute, a continuing waiver of such breach, or of other breaches of
the same or other provisions of this Agreement.
16.3 Neither Party shall be liable for any breach of its obligations under or arising out of this Agreement resulting from a cause beyond
its reasonable control and shall give notice forthwith to the other of such a cause giving particulars of the cause and the notifying
Party’s reasonable assessment of the anticipated effect on its obligations under this Agreement. Such causes include acts of God,
civil commotion, strikes, labour disputes, and governmental demands or requirements.
16.4 A person who is not a Party to this Agreement has no right under the Contracts (Rights of Third Parties) Act 1999 to enforce any
term of this Agreement but this does not affect any right or remedy of a third party which exists or is available apart from that Act
16.5 If the Candidate is a Company Candidate, the signatory to this Agreement on behalf of the Company Candidate and its Connected
Person agree or shall be deemed to be bound by these Conditions as if he were also a party to this Agreement, and he agrees
to perform or procure the performance of all the obligations and conditions entered into by the Company Candidate and the
Connected Person where applicable and the Candidate shall arrange all proper insurance and comply with all laws and regulations
concerning performance of the Candidate Services by the Connected Person of the Candidate.
16.6 Assignment and Sub-contracting
16.6.1 This Agreement shall be binding upon and enure for the benefit of the successors in title and permitted assignees of the Parties.
16.6.2 The Candidate warrants and represents that it is acting on its own behalf and is not acting as an agent for or on behalf of any
third party.
16.6.3 Subject to Condition 16.6.4, the Candidate shall not be permitted to assign or sub-contract this Agreement without the prior
written permission of DRC Locums.
16.6.4 A Company Candidate shall be entitled, upon reasonable notice to DRC Locums and satisfactory compliance with Condition 5.1,
5.2, and 5.3 in respect of that other person, to engage any person to perform the Candidate Services for a particular Assignment
other than the Connected Person who has already worked on that Assignment or who is intended at the date of the Application
Form to be supplied by the Company Candidate to perform the work.
16.7 Each of the Parties hereto acknowledges that it has read this Agreement in full, understands it, and agrees to be bound by its
terms. The Parties further agree that this Agreement is the complete and exclusive statement of their agreement and supersedes
all proposals (oral or written), understandings, representations, conditions, warranties, covenants, and all other communications
between the Parties relating thereto.
16.8 The validity, operation, interpretation, and construction of this Agreement shall be governed by and determined in accordance
with the laws of England and Wales and the Parties irrevocably agree to submit to the exclusive jurisdiction of the English Court.
16.9 Before taking any court proceedings for any dispute arising out of this Agreement (apart from emergency court proceedings), the
complaining Party shall notify the other Party in writing of the dispute in as much detail as possible and the Parties agree to try
informal conciliation within twenty Business Days of the notice of the dispute. If the dispute cannot be resolved, the Parties agree
to use the Recruitment & Employment Confederation conciliation service to try to resolve the dispute amicably before taking any
other step. If the dispute is not resolved to mutual satisfaction within forty Business Days after notice of the dispute has been
given, a Party may submit the dispute to the Court. This Condition does not affect the right of either Party to terminate this
Agreement or to apply for urgent relief from the Court.
16.10 These terms and conditions can be amended only in writing signed by a director of DRC Locums and the Candidate.

DRC Group is part of DRC Holdings

drc locums 13
Limited which is registered in
England no. 06550485.
 Self bill form
Partis House, Davy T +44 (0)1908 545 999
Avenue, Knowlhill, F +44 (0)1908 545 888
Milton Keynes, MK5 8HJ
E info@drclocums.com
www.drclocums.com

Please complete and email to compliance@drclocums.com

This is an agreement in relation to a self billing procedure between :

Signatures
DRC Locums Limited (DRC Locums, the “self biller”) VAT number 755
8761 82 and...
For and on behalf of DRC Locums
The “self billee” Name

Position

VAT number

Signature

Date
For the duration of this agreement the self biller (DRC
Locums) agrees to :

1 Issue self bill invoices for all supplies made to them by the supplier

2 Create self bill invoices that show the supplier’s name, address and
For and on behalf of “self billee”
VAT registration number, together with all other details which form a
full VAT invoice as dictated by HMRC Name
Kazim Abbas
3 Create a new self billing agreement in the event of a VAT number
change for either party
Position
4 Inform the supplier if the issue of self bill invoices will be out sourced Surgical Registrar (Doctor)
to a third party.
Signature
For the duration of this agreement the self biller agrees to :

1 Accept invoices raised by the self biller on their behalf

Date
2 Not to raise “hard copy” paper invoices
06 03
02 2018
3 Notify DRC Locums immediately if they change their VAT registration
number of VAT status or sell their business or part of their business.

This agreement expires after a period of twelve

months

DRC Locums Limited is registered

in England no. 04154956.


Declaration
The terms & conditions as stated previous, set out the contractual relationship between
DRC Locums and you, the candidate. They define DRC Locums’s responsibilities to
you, the candidate and they also set out the obligations of the candidate in respect of
any assignments undertaken and applicable regulations whilst working with the DRC
Locums.

DRC Locums urges the candidate to carefully read this health & safety manual including
the terms & conditions enclosed alongside the candidate handbook before entering into
this agreement.

I have read both the content within this health & safety
Please cut along this dotted line and return to DRC Locums as soon as possible.

manual and the candidate handbook and accept the

Terms & Conditions stated within this document.

Signature

Date

06 02 2018

DRC Group is part of DRC Holdings

drc locums 15
Limited which is registered in
England no. 06550485.