ࡱ> TWS fbjbj 4JX 00000DDD8|DD#"d(#######$%c(4#04#004I#hhhX00#h#hh:2 , P/^ "_#0#h R(( (0 @h4#4##( : TAUNTON & SOMERSET NHS FOUNDATION TRUST APPLICATION FORM FOR ACCOMMODATION REQUIRED FOR 7 DAYS OR MORE This form MUST be completed in full and sent to:  HYPERLINK "mailto:accommadmin@tst.nhs.uk" accommadmin@tst.nhs.uk or accommodation will not be agreed. FULL NAME OF APPLICANT (BLOCK LETTERS)TITLEDr/Mr/Mrs/Miss/Ms (Please circle)SURNAME:FIRST NAME:PRESENT ADDRESS (BLOCK LETTERS)MOBILE NOEMAIL ADDRESSPERMANENT ADDRESS (BLOCK LETTERS) FOR STAFF TAKING UP NEW APPOINTMENT/STUDY WITH THIS TRUST GRADEDEPARTMENT/WARD and MANAGER(Please state) ARE YOU PAID BY TAUNTON & SOMERSET NHS FOUNDATION TRUST YES/NO PAID BY OTHER (Please state)DATE PLACEMENT IS DUE TO COMMENCE: DATE PLACEMENT IS DUE TO FINISH: DATE ACCOMMODATION IS REQUIRED:DATE ACCOMMODATION IS DUE TO FINISH (It is important to quote correct leaving date as this could affect the final invoice amount) (if placement is extended, accommodation is not guaranteed) TYPE OF ACCOMMODATION REQUIRED*Single room / *Double room / *Married House (2 bed terraced). (*Delete as appropriate)PAYMENT FOR ACCOMMODATION - Please tick as applicable. If this section is not completed, we have the right to decline your application. Upon completion of this form, I agree to: make payment of my accommodation upon receipt of invoices during my placement; or agree to deductions for the provision of accommodation being made from my salary direct on a monthly basis (as appropriate); or (NOT AVAILABLE FOR AGENCY STAFF) the payment of my accommodation be covered by Taunton & Somerset NHS FT or my agency (if applicable) Bookings should be made at least 2 weeks in advance of requirement. No guarantee of availability is made, however every effort will be made to accommodate your requirements. PLEASE NOTE, YOU WILL BE REQUIRED TO CHECK OUT AT 10AM AT THE LATEST (IF ANY SPECIAL CIRCUMSTANCES ARE REQUIRED, PLEASE CONTACT US ASAP) Signature . Date PLEASE RETURN COMPLETED FORM FOR PROCESSING TO NATASHA FICAROTTA, SENIOR ADMIN ASSISTANT, MUSGROVE PARK HOSPITAL, TAUNTON, SOMERSET TA1 5DA. 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