Staff Lottery Application Form

Complete the below form to join our Staff Lottery!

How to save the Staff Benefits and Wellbeing section to your home screen

iPad or iPhone

Launch “Safari” app.
Enter into the address field the URL of the website you want to create a shortcut to. Tap “Go.”
Tap the icon featuring a right-pointing arrow coming out of a box along the top of the Safari window to open a drop-down menu.
Tap “Add to Home Screen.” The Add to Home dialog box will appear, with the icon that will be used for this website on the left side of the dialog box.
Enter the name for the shortcut using the on-screen keyboard and tap “Add.” Safari will close automatically and you will be taken to where the icon is located on your iPad’s desktop.

Android

Launch “Chrome” app.
Open this link.
Tap the menu icon (3 dots in upper right-hand corner) and tap Add to homescreen.
You’ll be able to enter a name for the shortcut and then Chrome will add it to your home screen.

Title

Full name (including middle names)*

Job role

Department

Phone number

Work address

Payroll number*

Work email*

Personal email*

Employed by (please tick):

York and Scarborough Teaching Hospitals NHS Foundation Trust

York Teaching Hospital NHS FT LLP (Facilities Management)

Part A

I am not a member of the lottery but I want to join

Please select the amount of numbers you'd like on the lottery (£2 per number per month)

Part B

I am already a member of the lottery but want extra numbers

Number of numbers already held

Number of additional numbers required (not including already held)

Declaration

I authorise the deduction of lottery entry fees from my salary with effect from the month prior to my number(s) being entered into the draw following receipt of this form by the lottery office, until cancelled by me in writing or until the termination of my employment with York and Scarborough Teaching Hospitals NHS Foundation Trust or LLP. I acknowledge that I have read and understand the York Teaching Hospitals Foundation Trust staff lottery rules.*

Are you happy for your name to be used in the winners list should you be lucky enough to win*

Please note: The Finance Department deals with lottery applications on the 8th of every month. You will receive a confirmation letter with your lottery numbers and staff card shortly after this date.

* required fields

Image of Pink page break

Click here to return to the 'Staff Lottery' page