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
* Required
Full name
*
Your answer
Date of birth
*
Your answer
Nationality
*
Your answer
Residential address
*
Your answer
Mobile no.
*
Your answer
Email address
*
Your answer
Gender
*
male
female
prefer not to say
Required
Location
*
Your answer
Marital status
married
single
Divorced
other
Position
*
Nurse - RGN
Nurse - RMN
Other
Required
If other, please specify
Your answer
Specialty
Your answer
How many agencies are you registered with?
*
1
2
3
4
5
more than 5
Required
Name(s) of registered agency
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Your answer
Contact email of agency Consultant
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Your answer
Which of the below apply to you
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This is my only Job
I have another Job and receive Pension
This is my first Job since April
Required
Do you have a P45 from previous employer
Yes
No
N/A
Preferred method of payment
*
PAYE UMBRELLA
SELF EMPLOYED
LTD COMPANY
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
*
Your answer
Account name
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Your answer
Account number
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Your answer
Sort Code
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Your answer
Preferred mode of contact
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Text
Email
mobile phone
Required
NI number.
*
Your answer
How did you hear about us?
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Word of mouth
Member referral
Advert
Contractor Hub
Other:
Required
Do you consent to the processing of your information by ANU as per GDPR?
*
Yes
No
Required
Signature/initials
*
Your answer
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.
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