Candidate Declaration Form

Guidance Notes: Data Protection, Handling and Retention

The Data Protection Act 2018 requires Arcadia to advise you that we will be processing your personal data.
Processing includes: holding, obtaining, recording, using, sharing and deleting information.

The information that you provide on this form, on any document and on any CV given, will be used by Arcadia
Nursing to provide you recruitment services. In providing these services to you, you consent to your personal data
being included on a computerised database and consent to us transferring your personal data to our Clients. We
may check the information collected with third parties, auditors or cross-reference it with other information held
by us.  We may also use or pass your data to certain third parties in order to prevent or detect crime, to protect
public funds, or in any other way required by law. You may withdraw consent at any time  by emailing the
Compliance Manger at compliance@arcadia-nursing.co.uk

The data Arcadia processes may include ‘sensitive personal data’. The Data Protection Act 2018 defines ‘sensitive
personal data’ as racial or ethnic origin, political opinions, religious or other beliefs, trade union membership,
physical or mental health, sexual life, criminal offences, criminal convictions, criminal proceedings, disposal or
sentence.

Furthermore, where you apply for a position which involves regulated activity, this data will also include any barring
decisions made by the Disclosure and Barring Service (DBS) on the Children’s and/or Adults barred lists under the
terms of the Safeguarding Vulnerable Groups Act 2006 (as amended by the Protection of Freedoms Act 2012).

All information that you provide to Arcadia will be processed in accordance with the Data Protection Act 2018 and
GDPR. It will be used for the purpose of determining your application for this position and, ensuring that you
remain suitably compliant to perform the duties required by this position (on an on-going basis). It will also be used
for the purposes of enquiries in relation to the prevention and detection of fraud.

Where a decision has been made in respect of your appointment, Arcadia will not retain this declaration form, or
any information you provide, for any longer than necessary for the purposes for which it is being processed, in
accordance with GDPR.

This declaration will be retained securely and in confidence. Access to this information will be restricted to
designated persons within the organisation authorised to view it as a necessary part of their work.

If you believe that there is an issue with the manner in which Arcadia processes your data, you have the right to
complain to the Information Commissioners Office (ICO): https://ico.org.uk/for-the-public/raising-concerns/

“I have read the ‘Guidance Notes’ and I consent to my Personal Data being used by Arcadia for the purpose of
providing recruitment services including, assessing my application, maintaining my compliance and for enquiries in
relation to the prevention and detection of fraud.”

I agree (please tick) ☐ Initial: ……………………………………………………….

Professional Registration Agreement

Nurses, Locums and Registered Health Professionals are expected to adhere fully to the code of conduct, policies
and guidelines set out by their relevant professional body including maintaining their valid Professional Registration
and not undertaking tasks for which you are not adequately trained. By ticking/signing this declaration, you agree
that you are fully aware of these and will adhere to them at all times during your assignments with Arcadia.

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

Furthermore, by ticking/signing this declaration, you confirm that you are not currently nor have you ever been the
subject of any investigation or fitness to practise proceedings by any licensing or Regulatory Body in the United

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Kingdom or in any other country, and that you are not subject to any other prohibition, limitation, or restriction
that prohibits Arcadia from considering you for the position to which you are applying.

I confirm (please tick) ☐ Initial: ……………………………………………………….

If you cannot provide confirmation, please contact Arcadia’s Compliance Team immediately to discuss this.

Indemnity Insurance Disclaimer

If you intend to be engaged with Arcadia via a Personal Services (Limited) Company (PSC), it is your legal
responsibility (The Health Care and Associated Professions (Indemnity Arrangements) Order 2014) to ensure that
you have appropriate indemnity insurance arrangements in place. This may be through your Professional Body,
Union Membership or through another Insurance Provider. By ticking/signing below, you agree that you are aware
of this requirement and accept all liability for your insurance and indemnity cover arrangements.

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

References

Arcadia will request references from your previous employers to confirm your suitability for the position to which
you are applying and you consent to this activity. You understand it is Arcadia policy to only accept
authenticated/validated references. By ticking/signing below, you agree that you are aware of this requirement.

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

Security/Status Checks Disclaimer

In line with the nature of the work you will be undertaking, you are aware that there will be a variety of
security/status checks carried out by Arcadia and you consent to this. Furthermore, you agree to these checks
continuing on an ongoing basis or as Arcadia sees appropriate, and to Arcadia retaining copies of all documentation
relating to this process during the period of time you undertake shifts with Arcadia, and in line with the Data
Protection Act 2018 & GDPR after you cease employment. By ticking/signing below, you agree that you are aware
of these requirements.

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

Protecting Patient Safety

You are aware of Appendix 3 in the “Guidance for employers on sharing information about a Healthcare Worker
where a risk to public or patient safety has been identified, July 2013, NHS Employers”, in which you are required to
provide details of other healthcare organisations to which you provide/have provided services, either under a
contract of employment or via a contract for services, and agree to do so on request from Arcadia in order to
ensure your conduct and performance is not below required standards. By ticking/signing below, you agree that
you are aware of this requirement.

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

Audit Consent

In line with the nature of work you will be undertaking, you are aware that all confidential documentation given (in
your personnel file) in line with Arcadia’s Compliance Procedures may be subject to audit by: Arcadia, Relevant
Legal Bodies, Customers of Arcadia, Framework and Regulatory Bodies, and any duly appointed representatives of
these organisations. Access to your information will be conducted in line with the Data Protection Act 2018 and
Arcadia will maintain a record of any such access exercised. By ticking/signing below, you agree that you are aware
of this requirement.

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I am aware and agree (please tick) ☐ Initial: ……………………………………………………….
DBS Privacy Policy – Enhanced paper applications declaration
Please use the link for the DBS Privacy Policy or request a hard copy from Arcadia staff. Please sign the
below declaration to confirm that you have read and understood the DBS Privacy Policy.

This signed consent form must be submitted to Arcadia in conjunction with your DBS Application Form.
We recommend that all DBS Application Forms are sent to us using recorded delivery.

We cannot process any DBS applications that are submitted without this signed consent form.

I have read the Standard/Enhanced Check Privacy Policy for applicants at:

https://www.gov.uk/government/publications/standard-and-enhanced-dbs-check-privacy-
policy/standard-and-enhanced-dbs-check-privacy-policy

or the paper copy provided to me by Arcadia. I understand how DBS will process my personal data and
the options available to me for submitting an application.

Name:

Signature:

Date:

If you already possess a valid DBS certificate which is also registered on the Online Update Service, then
please confirm that you have read and understood the Standard/Enhanced Check Privacy Policy for
applicants at:

https://www.gov.uk/government/publications/standard-and-enhanced-dbs-check-privacy-
policy/standard-and-enhanced-dbs-check-privacy-policy

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

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Third Party Checks

You agree that Arcadia may cross-reference all of your information with selected third parties including,
Professional Regulatory Bodies, DBS Update Service, Referees, etc., or with other information held by Arcadia.
Arcadia may also use or disclose your information to appropriate third parties to prevent or detect crime, to protect
public safety/funds, or in any other manner required by law. By ticking/signing below, you agree that you are aware
of these requirements.

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

Transfer and Introduction Fees

You are obliged to immediately inform Arcadia where any Client offers you direct employment within 12 months of
your last placement through Arcadia, and are aware that the Client will be subject to introduction/transfer fee
terms. By ticking/signing below, you agree that you are aware of this requirement.

I am aware and agree (please tick) ☐ Initial: ……………………………………………………….

General Terms and Conditions

I hereby confirm that the information provided to Arcadia (now and in the future) concerning my personal data,
professional status, experience, fitness to practice and state of health is true and accurate. I consent to my personal
data, professional information, employment and educational history being shared with Clients in pursuant of
Recruitment Services. Furthermore, I understand that it is my responsibility to disclose now and in the future any
information which might affect my ability or suitability to carry out the duties expected while working with Arcadia,
including (but not limited to):

 Health matters such as: injury or pregnancy;

 Criminal convictions (pending or confirmed); or
 Investigations by Professional Bodies.

I understand that should the information I have given be untrue, I accept full responsibility for any consequences
this may bring.

I confirm and agree (please tick)  Initial: ……………………………………………………….

Please sign and date this form below:

Signature:

Name (in block capitals):

Date:

If you wish to withdraw your consent at any time after completing this declaration form or you have any enquiries
relating to information required in this form, please contact the Compliance Manager on 01472 233 445. All
enquiries will be treated in strict confidence.

This form contains personal data as defined by the Data Protection Act 2018 (underpinned by the General Data
Protection Regulation 2018). This data has been requested by Arcadia exclusively for the purpose of recruitment.
Arcadia must protect any information disclosed within this form and ensure that it is not shared with any party
which is not authorised to have this information in line with all current GDPR guidelines.

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