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Staff Benefits and Wellbeing

Medical accommodation form

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This form should ONLY be completed by Medical & Dental Staff commencing in a post based at Scarborough/Bridlington Hospital – all other staff groups should contact the Facilities Helpdesk in the first instance via email facilitiesmanagementhelpdesk@ythfm.nhs.uk or on 01904 725566.

Please do not complete this form unless you have been invited to do so in your formal offer issued by the Medical Recruitment Team.

Please note: This service is not offered by Staff Benefits, if you have any querys please contact the Facilities Helpdesk team on yhs-tr.medicalaccommodationapproval@nhs.net

This is a booking request form only and does not guarantee the availability of hospital residential accommodation for you. The Trust has a limited number of residential options for employees and cannot accommodate every request. To be eligible for consideration for residential accommodation you must have received a formal offer of employment (NHS contract). In your communication with our teams please ensure that your treatment of staff is always in line with the Trust's values & behavioural framework.

Please complete all details where possible.

Personal details of resident

Title*

First name of resident*

Last name of resident*

Gender*

Accommodation required*

Will this be your main home? *

Name of employer*

Job title*

Job role

Disability/Access Information: (Please add additional details of any requirements for access e.g., ‘downstairs room due to mobility issue’ and advise us of any reason that may impede you during an evacuation (e.g., hearing or sight impairment)

Current details

Current home address and postcode of resident*

Mobile number of resident

Email address of resident

Details of accommodation required

Arrival date*

Expected departure date *

Site accommodation required:*

Occupancy*

Car registration number

This is required for any residents of Orchards Block on the hospital site

Payment method (tick and complete as applicable)

Salary deduction (only available if employed directly by York & Scarborough Teaching Hospitals NHS Foundation Trust or YTHFM)

If paying by salary deduction, please provide your National Insurance number (required for payroll to link to employee account)

Department payment (if agreement has been made for the department to pay, please provide budget code and written consent from budget holder)

Self pay (if you choose to pay online a dedicated link will be sent by email)

Employment questions

Answers provided in this section will be used to qualify your applications priority and authorisation for the accommodation team to accept your request (Failure to complete all boxes in this section will invalidate your request and it will be rejected with no booking being made)

Do you currently live in the UK?

Reason for application

Approximate travel time to your current home address if in the UK to your base hospital? (In driving time or journey time if using public transport)

Contract

Contract type - fixed term

Accommodation will be provided for the full dates of the fixed-term contract where available

Contract start date

Contract end date

Contract type - permanent

Accommodation can only be requested for first six months of Trust contract

Contract start date

Additional information

Please only complete this section if applying for family house. For single room requests please ignore this section

Please give details of occupants to live in our property, including full name, title, date of birth (including applicant)

Details of pricing available on Accommodation***. This form will automatically be sent to the Medical Staffing Office. The Facilities Management Helpdesk will be in contact once an eligibility decision has been made

* required fields

Click here to return to the main Staff Benefits menu.