APPLICATION FOR WORK EXPERIENCE

Thank you for your interest in a work experience placement at the RNOH.

Work experience is an unpaid, short-term placement, undertaken by students wishing to learn

about a particular job or area of work. It offers an opportunity for students to find out what skills
employers look for when they are recruiting to a position and provides them a chance to
develop their self-confidence and communication skills.

Individuals interested in a placement with the trust should contact the manager/department
directly to secure a work placement. Please find the current list of contacts on our website

 To ensure fair opportunity and to manage demand for placements, work experience
placements are 1 to 5 days in duration.
 Students are permitted one placement only.
 Students cannot be hosted in an area where a family member or close friend is working
 Students must be aged 16 old and have the permission of their parent or guardian.
 Students cannot be placed out of hours, weekends or bank holidays.

To request a work experience placement please complete the application form below and send
to the RNOH staff member who you wish to sponsor your placement.

Your application will then be considered to see if it can be accommodated during the
timeframe requested.

Once approved, you will be issued with a work experience placement agreement which will
need to be signed and returned prior to commencement of your placement.

Please note, the Trust does not have any accommodation available for those on observer
placements at the Trust.
APPLICANT DETAILS

Name of applicant

Address

Telephone number

Email address

Date of Birth
ID Document (please
attach)

PROPOSED SPONSOR DETAILS

Name of staff member requested to

sponsor placement

Department/Speciality of interest

Proposed start and end date START: / / ENDING: / /

Days available to be on-site MONDAY / TUESDAY / WEDNESDAY / THURSDAY / FRIDAY

Please detail below why you wish to have an work experience placement with the RNOH

Please detail your current employment/education (ie studying/employed/in between jobs)

Please detail any adjustments or support you may require during your placement

Please provide details of two referees who can be contacted to provide a reference if required.
At least one should be your current employer/educational establishment tutor.

Referee 1
Name of referee:
Relationship to applicant:
Contact telephone number:
Contact email address:

Referee 2
Name of referee:
Relationship to applicant:
Contact telephone number:
Contact email address:

Signed (applicant)

Print name

Date
SUPPORT FOR APPLICATION (to be completed by sponsor).

I/my team undertake to supervise the person named above during their work experience placement with the Trust.

I also undertake to ensure that the person is aware of departmental health and safety regulations and any protocols
and procedures appropriate to the placement in line with the observer placement induction checklist.

SIGNED:

PRINT NAME:

DATE: / /
 WORK EXPERIENCE AGREEMENT TERMS & CONDITIONS

This agreement is intended for individuals who are carrying out a temporary unpaid work
placement with the Trust, including observers (clinical and non-clinical), non-clinical students
and non-clinical researchers.

Nothing in this agreement is intended to confer employment rights or to create an employment

relationship between you and the Trust. If you have any queries about this document or about
your placement with the Trust, please contact the Workforce department as soon as possible.

1 WORK EXPERIENCE AGREEMENT

1.1 This agreement is intended for the candidate mentioned in the application who
is carrying out a temporary work placement with the Trust.

1.2 This agreement will therefore commence/terminate on the dates mentioned in

the application.

1.3 For the avoidance of doubt this agreement DOES NOT allow any direct patient
contact between you and a patient.

2 TRUST VALUES

2.1 The Trust Values are that the organisation and those working for it are:

Patients first, always

Excellence, in all we do
Trust, Honesty and Respect, for each other
Equality, for all

2.2 These values are integral to the Trust and the work we do. You are asked to
observe and abide by these values at all times during your placement.

3 POLICIES AND PROCEDURES

3.1 You acknowledge that during your placement, you are required to comply with
all Trust rules, instructions, policies and procedures. Full copies of the latest
versions of the Trust’s policies and procedures are available on the Trust’s
intranet.

4 DISCLOSURE AND BARRING SERVICE (“DBS”) CHECKS

4.1 This is only required where individuals are required to act in an unsupervised
capacity.

4.2 In accordance with the Rehabilitation of Offenders Act 1974, the Trust reserves
the right to undertake certain checks, including a DBS check, as it deems
appropriate.

4.3 It is the responsibility of the individual to supply a valid DBS to the level required
for the placement. The DBS disclosure should have been issued within the last
3 years of the placement commencing.

4.4 On receipt of an unsatisfactory DBS check, the Trust reserves the cancel your
placement and/or ask you to leave the Trust premises immediately. In the event
an individual obtains a criminal record, conviction or warning they have an
obligation to inform the Trust via the supervisor.
5 HEALTH AND SAFETY

5.1 In addition to the Trust’s responsibilities under Health and Safety legislation,
you are reminded of the need to take reasonable care for the health and safety
of yourself and of others in your work activities and to co-operate with the Trust
in the discharge of its statutory duties. You must adhere strictly to the Trust’s
policies and procedures on health and safety and report all accidents,
dangerous occurrences, unsafe practices or damage promptly using the Trust’s
incident reporting system. You must make use of appropriate training, safety
equipment, protective clothing and footwear and attend training. Failure to
comply with these requirements may result in you being asked to leave the
Trust immediately.

5.2 You must familiarise yourself with the fire evacuation procedure for their work
area and for the Trust.

6 CONFIDENTIALITY

6.1 You must at all times be aware of the importance of maintaining the
confidentiality of information gained by you during the course of your
placement. This will in many cases include access to personal information
relating to patients, service users and members of the public. You must treat all
information in a discreet and confidential manner. Please note that your
obligation to respect the confidentiality of information you encounter continues
after your placement with the Trust comes to an end.

6.2 Data protected information regarding patients and service users must not be
disclosed either verbally or in writing to unauthorised persons. Written records,
computer records and correspondence pertaining to any aspect of the Trust’s
activities must be kept securely at all times and carefully locked away at night.

6.3 You have an obligation to ensure that computer systems which you use are
protected from inappropriate access e.g. by ensuring that personal access
codes are kept secure.

6.4 All data held by the Trust must conform to the requirements of the Data
Protection Act 1998 (“DPA). Under the DPA, patients, service users and staff
have a right of access to their records, but you should be aware that
unauthorised disclosure of personal information (including such information that
is recorded on computer) is unlawful. Further guidance is available on request
from the Workforce department.

6.5 If it is necessary for you to share Trust confidential information, you must make
sure that as far as is reasonable this information will be exchanged on a strictly
‘need to know’ basis, using the minimum that is required and only for the
purpose for which the information was given. If you are unsure about this, you
should seek advice from the Workforce department or the Trust’s Caldicott
Guardian.

6.6 Please note that nothing in this agreement is intended to or shall prevent you
from making a lawful protected 'whistleblowing' disclosure.

7 PROPERTY

7.1 The ownership of any intellectual property generated in the course of your
placement belongs to the Trust, unless agreed otherwise in writing between
yourself and the Trust.

7.2 The Trust accepts no liability for loss, damage or disrepair arising to your
personal property or belongings on its premises or its grounds; whether by
 burglary, fire, theft or other means, and will not reimburse you in respect of the
same. You are encouraged to make arrangements for your personal insurance
to cover such risks.

7.3 Whenever called upon to do so, you shall return to the Trust such property
belonging to or entrusted to the Trust, as it specifies and without keeping
copies. For the avoidance of doubt, the Trust hereby specifies that all property,
including but not limited to computer software and hardware, mobile
telephones, blackberry handsets, diaries, security passes, keys, files,
databases, lease car, reports, minutes of meetings, plans, policies, projections,
accounts, reports, drafts, extracts, summaries, reproductions and any other
documentation or media for storing information whether written, audio, digital or
electronic, is to be returned to the Trust forthwith.

7.4 You must observe all security procedures at all times. Any unauthorised
conduct that causes loss or damage to the Trust may result in you being asked
to leave the Trust premises immediately.

8 RESEARCH GOVERNANCE

When undertaking research, you must adhere to the Trust’s research governance
procedures in line with the Department of Health’s Research Governance Framework
for Health and Social Care.

9 RIGHT TO WORK AND STUDY IN THE UK

9.1 You confirm that you have the right to work / study or undertake work
experience in the United Kingdom with a valid passport or visa. You will be
expected to provide this before you start your placement.
9.2 This placement agreement will be null and void if you are unable to show,
whether on a temporary or permanent basis, that you have a right to work /
study or undertake work experience in the United Kingdom.

10 IDENTIFICATION
In the interests of security, you must wear and visibly display an identity badge if issued
by the Trust at all times during your placement.