New starter form

This form is for new Doctors joining EKHUFT. This will need to be completed in full ready for IT access to be created for the main hospital network and some other IT systems which you will require when you start with the Trust. This will also enable the Trust to begin completing ID checks required for your ID and Smartcard badges.

ra01-doctors

Your details

Title ^*

First name ^*

Last name ^*

Middle name(s)

National insurance number ^*

Date of birth ^*

Role / job title ^*

Department or ward

Speciality

Site ^*

Email ^*

Please use your existing NHS email address if you have one, if one is not used a new NHS email address will be created for you.

Existing NHSmail Account? ^*

Yes No

Mobile number ^*

IMPORTANT - required for applying for NHS Care ID/Smartcard

Professional registration ^*

GMC registration number for example

Welcome day

IMPORTANT- Please supply the date you will be attending your Welcome Day.

Final working day if known

Previously employed at another Trust?

Smartcard UUID

Enter the long number printed on the card.

Reason for application

Your ID and documents

1 x clear passport size photo and 3 x forms of ID will be required to be able to prepare your ID and Smartcard. This must include at least one of the following ID documents:
- 1 x photo, with 2 x name and address
- or 2 x photo with 1 x name and address

Photo requirements:
• Photo must be clear, with no flash reflections and no 'red eye'
• must show both edges of the face clearly and must show a full front view of face and shoulders, squared to the camera.

Example of an acceptable image .

Example of unacceptable image .

ID requirements (photo ID, and, name and address):
• Photo ID must include passport/driving license or valid ID/resident card.
• Statement must include full name and address of were currently residents, must be within the last 3 months or if council tax then this years period.
• NO Mobile phone statement will be accepted.

Your photo and documents

Drop files here or click to upload

Please upload your photo and ID documents - you can upload multiple files through this upload field.

Terms and Conditions

Before you attend the Induction it is advisable that you read the ‘NHS Smartcard: Terms & Conditions’ as you will be asked to sign as confirmation that you understand and will uphold the national standards before your Smartcard is released.

I have read, understood and accept these T&Cs

I confirm that I will bring that ID with me on the induction day to be verified

PLEASE ENSURE YOU HAVE UPLOADED YOUR PHOTO AND ID DOCUMENTS (ABOVE) BEFORE CLICKING SUBMIT.