I can confirm that I have read this document fully and that all the information provided to Xpress Healthcare Limited is correct and to the best of my knowledge and belief. I give consent to contact referees regarding the information I have provided unless specified otherwise. I will inform Xpress Healthcare Limited should anything change that might affect my position and I understand the information given on this form will be processed by computer and used for registration purposes, under the Data Protection Act 1998. Declarations

1. I understand that if I am at any stage charged or cautioned after signing this declaration, I must inform Xpress Healthcare Limited.

2. I acknowledge that I have been given a copy of the terms and conditions of service issued by Xpress Healthcare Limited, which is mine to keep, and furthermore that I have read those terms and conditions and agree to abide by them.

3. I am not aware of any condition, medical or otherwise, which would affect or limit my employment or performance, other than those declared in my Occupational Health Form.

4. I acknowledge and confirm that Xpress Healthcare Limited is authorised to apply for and obtain a Garda Vetting check and references from any previous employers and educational establishments.

5. I declare that the information given herein is true and complete and is not presented in a way intended to mislead. I agree that if I have given false or misleading information or omit to give relevant information now or in the future that Xpress Healthcare Limited may cease to offer me further agency placements without notice, as well as claim for recovery of any payments I have received, together with a claim for loss of profit to Xpress Healthcare Limited.

6. I agree that the maximum weekly working time specified in Regulation 4(1) and (2) of the Organisation of Working Time Act 1997 shall not apply to working with Xpress Healthcare Limited unless specified above, If Xpress Healthcare limited have rostered for hours more than stipulated, I am duty bound to inform and change the roster.

7. I acknowledge that my personal details will be stored and handled correctly by Xpress Healthcare Limited in accordance with the Data Protection Act of 1998 and 2003, however, I agree that they may be made available for audit/review by relevant third parties. (This is relevant for all information including all documents - Garda Vetting, Occupational Health, References).

8. I understand that if I am on a student visa I can only work for 20 hours per week during term time. I understand that I have a responsibility to monitor this. In addition, if my position as a student changes, I must inform Xpress Healthcare Limited.

9. I will notify Xpress Healthcare Limited if there is any change in my visa status that would make me in-eligible to work.

10. I understand that all salaries paid include the 8% holiday pay already (as denoted in the payslip) and I can chose to defer this holiday pay on a later date, if requested 1 week before processing the payroll.

11. I understand that if I am solely responsible for my actions at the workplace and that Xpress Healthcare limited not responsible for any compensations or legal proceedings whatsoever, caused due to my negligence and it will be delt solely by me.

12. I will notify Xpress Healthcare Limited if there is any legal proceedings against me and would disclose any information that might hinder with my job.

13. I acknowledge that if any of my details stated on this Application Form change, or my circumstances change, which may affect my ability to work for Xpress Healthcare Limited, I must inform Xpress Healthcare Limited immediately.

14. I confirm that I am not currently under investigation, or currently suspended, by my professional regulatory body or being investigated by my current or previous employer. I will inform Xpress Healthcare Limited if I am under investigation or suspended by my professional regulatory body or employer at any point while working for Xpress Healthcare Limited.

15. I confirm that i will not contact/work a Nursing Home/CNU/Hospital/any place of work, I have worked in through Xpress Healthcare limited for a duration 365 days from when I worked there last. I also understand that I cannot work at any of these client locations through another employer/agency as well. I understand that i will be liable for legal proceedings from Xpress healthcare limited, if i do so.

16. I confirm that i will not attend work, if i have any flu, covid symptoms and will inform the management straight away- if i feel any of these symptoms.

17. I confirm that when asked about my working history (primarily, but not exclusively, for the purpose of the Agency Workers Directive) I will provide accurate information.

18. I confirm that whilst working for Xpress Healthcare Limited I am willing to work through any of the brands/subsidiary companies that form part of Xpress Healthcare companies. These include (but are not Limited to) Xpress Nursing, Xpress Home Care and Xpress Global Services. I understand that I will be informed at the time of placement which company / brand that I will be working for and will be provided with the relevant documentation to represent that company.