Please enable JavaScript in your browser to complete this form.This form is for Alliance for Better Care Associates to provide further information about their employment with the ABC Clinical Services team.Name *FirstLastDo you work for a GP Practice, ABC or other organisation? *ABCGP PracticeOther (please specify)Which GP Practice do you work for? *Bewbush Medical CentreBirchwood Medical PracticeBridge Medical CentreCaterham Valley Medical PracticeChaldon Road SurgeryCoachmans Medical PracticeCourtyard SurgeryCowfold SurgeryCrawley Down Health CentreCuckfield Medical Practice & The Vale SurgeryDolphins PracticeElizabeth House Medical PracticeFurnace Green SurgeryGossops Green SurgeryGreystone House SurgeryHolbrook SurgeryIfield Medical PracticeJudges Close SurgeryLangley Corner SurgeryLeacroft Medical PracticeLindfield Medical CentreMid Sussex Health CareMoatfield SurgeryMoat House SurgeryNewtons PracticeNorthlands Wood PracticeOrchard SurgeryOuse Valley PracticePark SurgeryPark View Health PartnershipPound Hill SurgeryRiverside Medical PracticeRudgwick Medical CentreSaxonbrook MedicalSilverdale SurgeryShip Street SurgerySmallfield SurgerySouthgate Medical GroupThe Brow Medical CentreThe Meadows SurgeryThe Village SurgeryThe Woodlands/Clerklands PartnershipTownhill Medical PracticeWall House SurgeryWarlingham Green Medical PracticeWayside SurgeryWhtyeleafe SurgeryWhat is your role type? *Administrative ClinicalRegistration Number (E.G. GMC, NMC, HCPC etc) *What is your job role? *ANPGPHCAHCPNursePAParamedicPharmacistWhat type of clinics are you qualified to do? *Adult immunisationsECGHealth ChecksKids immunisationsLong term health condition reviewsMH ReviewsPathologyPrescriberSmearsSMRSpirometryDo you have an NHS laptop? *YesNoDo you have a smart card? *YesNoWhat is your smart card number? *What location would you like to work at? *Burgess HillCrawleyEast GrinsteadEast SurreyHaywards HeathHorshamNorth TandridgeDo you have Lantum? *YesNoWhat type of contract are you on? *Fixed TermLocumLooking at joining ABCPay through GP PracticePermanentSelf EmployedZero HoursWhat is your UTR number? *Do you have indemnity insurance? *YesNoDo you have ICE access? *YesNoWhich Practices do you have ICE access for? *Bewbush Medical CentreBirchwood Medical PracticeBridge Medical CentreCaterham Valley Medical PracticeChaldon Road SurgeryCoachmans Medical PracticeCourtyard SurgeryCowfold SurgeryCrawley Down Health CentreCuckfield Medical Practice & The Vale SurgeryDolphins PracticeElizabeth House Medical PracticeFurnace Green SurgeryGossops Green SurgeryGreystone House SurgeryHolbrook SurgeryIfield Medical PracticeJudges Close SurgeryLangley Corner SurgeryLeacroft Medical PracticeLindfield Medical CentreMid Sussex Health CareMoatfield SurgeryMoat House SurgeryNewtons PracticeNorthlands Wood PracticeOrchard SurgeryOuse Valley PracticePark SurgeryPark View Health PartnershipPound Hill SurgeryRiverside Medical PracticeRudgwick Medical CentreSaxonbrook MedicalSilverdale SurgeryShip Street SurgerySmallfield SurgerySouthgate Medical GroupThe Brow Medical CentreThe Meadows SurgeryThe Village SurgeryThe Woodlands/Clerklands PartnershipTownhill Medical PracticeWall House SurgeryWarlingham Green Medical PracticeWayside SurgeryWhtyeleafe SurgeryDo you have Open Exeter Access? *YesNoWhich Practices do you have Open Exeter Access to? *Bewbush Medical CentreBirchwood Medical PracticeBridge Medical CentreCaterham Valley Medical PracticeChaldon Road SurgeryCoachmans Medical PracticeCourtyard SurgeryCowfold SurgeryCrawley Down Health CentreCuckfield Medical Practice & The Vale SurgeryDolphins PracticeElizabeth House Medical PracticeFurnace Green SurgeryGossops Green SurgeryGreystone House SurgeryHolbrook SurgeryIfield Medical PracticeJudges Close SurgeryLangley Corner SurgeryLeacroft Medical PracticeLindfield Medical CentreMid Sussex Health CareMoatfield SurgeryMoat House SurgeryNewtons PracticeNorthlands Wood PracticeOrchard SurgeryOuse Valley PracticePark SurgeryPark View Health PartnershipPound Hill SurgeryRiverside Medical PracticeRudgwick Medical CentreSaxonbrook MedicalSilverdale SurgeryShip Street SurgerySmallfield SurgerySouthgate Medical GroupThe Brow Medical CentreThe Meadows SurgeryThe Village SurgeryThe Woodlands/Clerklands PartnershipTownhill Medical PracticeWall House SurgeryWarlingham Green Medical PracticeWayside SurgeryWhtyeleafe SurgeryWhen are you available to start working in the preferred role? *What hours would you like to work? *SaturdaysWeekdays Weekday EveningsWeekday Evenings/SaturdayWould you prefer Face to Face or Remote work? *Face to FaceRemoteBothDo you have any of the following Windows computer logins? *Caterham DenePRHQVHSussex Practice LoginUTC CrawleyNoOther (please specify)Which clinical systems are you trained on? *EMISSystmOneNoneOther (please specify) Are you a named key holder for a GP Practice? *YesNoWhich GP Practice/Practices are you a named key holder for? *Bewbush Medical CentreBirchwood Medical PracticeBridge Medical CentreCaterham Valley Medical PracticeChaldon Road SurgeryCoachmans Medical PracticeCourtyard SurgeryCowfold SurgeryCrawley Down Health CentreCuckfield Medical Practice & The Vale SurgeryDolphins PracticeElizabeth House Medical PracticeFurnace Green SurgeryGossops Green SurgeryGreystone House SurgeryHolbrook SurgeryIfield Medical PracticeJudges Close SurgeryLangley Corner SurgeryLeacroft Medical PracticeLindfield Medical CentreMid Sussex Health CareMoatfield SurgeryMoat House SurgeryNewtons PracticeNorthlands Wood PracticeOrchard SurgeryOuse Valley PracticePark SurgeryPark View Health PartnershipPound Hill SurgeryRiverside Medical PracticeRudgwick Medical CentreSaxonbrook MedicalSilverdale SurgeryShip Street SurgerySmallfield SurgerySouthgate Medical GroupThe Brow Medical CentreThe Meadows SurgeryThe Village SurgeryThe Woodlands/Clerklands PartnershipTownhill Medical PracticeWall House SurgeryWarlingham Green Medical PracticeWayside SurgeryWhtyeleafe SurgerySubmit