Code of practice for the international recruitment

of healthcare professionals
Application form
Agency name:
Address:

Website:
Named contact:
Telephone:

Email :

Any other agency/trading arms/associated companies?

Yes

No

If yes, please provide details of your relationship:

Which professions does your agency recruit to? (tick as appropriate)

Nurses
Midwives
Healthcare scientists

Doctors
Allied health professionals
Other, please specify

Please indicate whether your agency recruits staff from within the UK or internationally.
From within the UK
International
Both
Do you recruit locums/temporary staff, permanent staff or both?
Locum/temporary staff
Permanent staff
Both
Which methods do you use to advertise vacant posts?
Journals (if so, which journals?)
Newspapers (if so, which newspapers?)
Internet (if so, which websites?)

Other, please specify

Do you recruit international healthcare professionals to posts in the NHS, independent
sector or both?
Independent sector

NHS

Both

Since 1 January 2001, from which countries have you recruited healthcare
professionals? If you have not yet recruited, please state which countries
you intend to recruit from.

Since 1 January 2001, have you charged a healthcare professional a fee?

Yes
If yes, please give a breakdown of these charges below.

No

If yes, was this fee for a permanent position or a supervised practice placement?
Permanent

Supervised practice placement

By signing this form, you are declaring that the information given on it is true and complete to the
best of your knowledge. If we discover that any information on this form is incomplete or incorrect,
or if you are not complying with the principles contained in the Code of Practice, NHS Employers
reserves the right to remove you from the list. We will also inform NHS organisations in England
and NHS Scotland Boards of the removal.
Please note that the NHS Employers logo is protected. Agencies who are successfully placed on
the list are not allowed to display the logo on their business materials, such as documents and
websites.
You are also reminded that inclusion on the list does not imply that you belong to a group that are
either preferred suppliers or recommended by the Department of Health or this organisation. It also
does not guarantee that NHS organisations will ask you recruit on their behalf.
Please scan and email your completed and signed application form to:
recruitmentandretention@nhsemployers.org.
Signed

Position

(Managing director or equivalent)

Date

This document confirms that you adhere to the revised Code of Practice for the
International Recruitment of Healthcare Professionals published on 8 December 2004.