locum meds timesheet
locum meds timesheet
Time Sheet
Section 1 – Please print details in block capitals. Email on completion to timesheet@locummeds.co.uk
Candidate Details:
First Name: ____________________________________ Surname: _______________________________________________
Client Details:
Name: ________________________________________ Site (if applicable): ______________________________________
Section 2 - To be completed by the Candidate
Please note that we can only accept one timesheet per week for each organisation that you work at. We advise that you have your
timesheet completed on your last working day of the week (MONDAY to SUNDAY).
BREAK BREAK Total Hours
Date Start Time Finish Time Start Time Finish Time Worked
Monday
Tuesday
Wednesday
Thurs day
Friday
Saturday
Sunday
Totals
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 proceedings. I consent to this disclosure of information from this form to and by any Locum Meds authorised body for the purpose of verification
of this claim and the investigation, prevention, detection, and prosecution of fraud.
Section 3 - To be completed by the Client – Senior Member of Staff Authorised only
I am an authorised signatory of the above named client. I am signing to confirm that the Job Profile Title and Band of Agency Worker and the hours/shift that I am
authorising are accurate and I approve payment. 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 proceedings. I consent to the disclosure of the information from this form and by any Locum Meds authorised body for the
purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud. I understand and agree to Locum Meds Terms of
Business http://www.locummeds.co.uk/2018-locum-meds-introduction-services-terms-conditions/ A fee will be charged (accordingly to our terms and conditions)
if the Candidate is poached by the client or another agency (to work for the client) without our permission or consent.
Authorising Signatory Name Signed
Position Date
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