Agency Nurses Umbrella online registration form
Agency Network Ltd t/a Agency Nurses Umbrella (ANU) is a Payroll company and not an employer. We liaise with your Employment business / Agency on your instructions to process your payment only. We are only able to process and pay you the hours and rates submitted to us by your Agency. Company registration no. 10837599, Registered office address: 27 Old Gloucester Street, London, WC1N 3AX
Full name *
Date of birth *
Nationality *
Residential address *
Mobile no. *
Email address *
Gender *
Required
Location *
Marital status
Position *
Required
If other, please specify
Specialty
How many agencies are you registered with? *
Required
Name(s) of registered agency *
Contact email of agency Consultant *
Which of the below apply to you *
Required
Do you have a P45 from previous employer
Preferred method of payment *
Required
Bank details
**please do not provide business bank account details. This will need to be verified. Details provided are solely for payment of contractor fees as per contract terms and conditions
Bank name *
Account name *
Account number *
Sort Code *
Preferred mode of contact *
Required
NI number. *
How did you hear about us? *
Required
Do you consent to the processing of your information by ANU as per GDPR? *
Required
Signature/initials *
Congratulations! Your registration is now complete. Thank you for your time taken to complete this form. For further inquiries, please call or WhatApp us on 07528069813. Alternatively, you can send an email to info@agencynurses.net.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy