Locum pharmacist onboarding

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Section 1 of 8 Booking details

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Booking details

About this locum engagement

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Booking date(s) *

— or add a date range —

How did you hear of this booking? *

Weekday rate (£/hr) *

Weekend rate (£/hr) (if applicable)

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Personal details

As registered with the GPhC

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Forename(s) *

Surname *

Date of birth *

Mobile number *

Postcode *

Full address *

Personal email address *

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GPhC registration

Registration details and FTP disclosure

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GPhC registration number *

Do you have any open or closed GPhC Fitness to Practise (FTP) issues? *

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Compliance documents

Upload your ID, indemnity and DBS

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Proof of identity

Type of ID *

Upload proof of identity *

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Select or drag your ID document here.
JPG, PNG or PDF

Please upload your proof of identity.

Indemnity insurance

Do you currently have indemnity insurance? *

Provider *

Policy number *

Expiry date * ⚠ This date appears to be in the past — please check.

Upload indemnity certificate *

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Upload your indemnity certificate.
JPG, PNG or PDF

Please upload your indemnity certificate.

Disclosure and Barring Service (DBS)

Has a recent DBS check been completed? *

DBS date of issue ⚠ This DBS is over 3 years old — please check.

DBS certificate number

Did the DBS raise any areas?

Upload DBS certificate *

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Upload your DBS certificate.
JPG, PNG or PDF

Please upload your DBS certificate.

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Payment details

Invoicing and bank information

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How will you submit invoices? *

Company name *

Company registration number *

Company registered address *

Will you add VAT to invoices?

Bank details

Bank name *

Account name (exact) *

Account number *

Sort code *

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NHS systems and access

NHS Mail, Smartcard, PMR, Sonar, PharmOutcomes, PharmSmart

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Do you have an NHS Mail address?

Do you have an NHS Smartcard?

PMR system — Apotec

Have you used Apotec (our PMR) before? *

Sonar Informatics

Do you have Sonar access?

PharmOutcomes

Do you have PharmOutcomes access?

PharmSmart

Have you used PharmSmart before?

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Training and accreditations

PQS training, NHS and private services

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Pharmacy Quality Scheme (PQS) training completed

NHS essential and advanced services

Are you accredited for any private services?

Which private services?

Upload accreditation certificates (optional)

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Upload certificates — label each one below.
JPG, PNG or PDF

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Declaration and submit

Review your answers and sign

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Declaration

I, —, confirm that:

All information provided in this onboarding form is true, accurate and complete to the best of my knowledge.
I hold a valid GPhC registration and am fit to practise as a pharmacist.
I have disclosed all Fitness to Practise issues, past and present.
My indemnity insurance will be in place for all booking dates.
I understand that providing false or misleading information may result in immediate termination of any engagement with SB Pharma Ltd.

Signature * Draw your signature using mouse or finger

Sign above

Please provide your signature before submitting.

✓

Onboarding submitted.

Thank you. Your information has been received securely. SB Pharma will be in touch to confirm your booking.