TIMESHEET Tel: 020

8233 2999
Email: [email protected]

Candidate Name Client Name

Job Title/Grade Department

Day Date Start Time Break Time End Time Total Hrs. Booking Reference No. Candidate Declaration

Monday I declare that the information I have given on this form is correct and complete
and that I have not claimed elsewhere for the Hours/shifts detailed on this
timesheet. I understand that if I knowingly provide false information this may
result in disciplinary action and I may be liable to prosecution and civil recovery
Tuesday proceedings. I consent to the disclosure of information from this form to and by
the NHS body and the NHS CFSMS for the purpose of verification of this claim and
the investigation, prevention, detection and prosecution of fraud. By signing this
timesheet, I have accepted the terms and conditions of the agency and I also
confirm that I have received a suitable client induction prior commencing this
Wednesday
assignment.

Thursday

Friday

Saturday

Sunday Candidate Signature

Totals Date

Placement assessment. Please √ as appropriate N/A Unsatisfactory Borderline Satisfactory Good Excellent Client Declaration

Clinical Skills in line with needs of position I am an authorized signatory for my ward/department/NHS body. I am signing to
confirm that the Job Role Title and Band of Candidate and the hours/shift that I
Relationship with patients & staff am authorizing are accurate and I approve payment. I understand that if I
knowingly provide false information this may result in disciplinary action and I
Timekeeping may be liable to prosecution and civil recovery proceedings. I consent to the
disclosure of information from this form to and by the NHS body and the NHS
Managing Workload CFSMS in England for the purpose of verification of this claim and the
investigation, prevention, detection and prosecution of fraud. Suspicions of fraud
Reliability may be reported, in confidence, to the NHS Fraud and Corruption Reporting Line
on 0800 028 4060 (within England). Our standard terms of business, which can be
Communication Skills found at www.easylinkmed.com, apply to this booking unless otherwise agreed in
Supervisory Skills writing by a Director of the Company. I confirm that I have given an induction
prior to commencing this assignment.
Organizational Ability Print Name

Sickness/absence record Client Signature

Overall clinical & professional performance in adherence Date:

with NMC Code of Practice and behavior
I can confirm that NO breaks were taken by the candidate in this timesheet. I authorise FULL PAYMENT with NO BREAKS to be deducted: Signed………………. Print………………………..

Bluelight Healthcare Recruitment Limited -Registered in England No. 09632382/ Daytime Homecare Limited – Registered in England No. 12042584
Registered Office: Collingham House, 6-12 Gladstone Road, Wimbledon, London, SW19 1QT