EmailMe Form - Covid Vaccination Confirmation

What is your name? *

First Last

What is your email address? *

What is the best number to reach you? *

Please select one of the below options: *

If you have had your first Covid vaccination, what date was this done (please ignore if you have not had your first vaccination):

DD / MM / YYYY

If you have had your second Covid vaccination, what date was this done (please ignore if you have not had your first or second vaccination):

DD / MM / YYYY

Please upload your Covid Pass as downloaded on the NHS app. For instruction on how to download your COVID Pass in PDF, please visit the following link: https://bit.ly/3vcKlld (please ignore if you have not had your first or second vaccination). This will be stored securely and in line with our Privacy Policy:

Please leave any further comments below for our Compliance team:

Please sign below to confirm that the information provided is true and correct. I understand that any incorrect information provided may result in immediate termination of employment.
I also understand that if I have not been vaccinated and cannot provide my NHS covid pass that Greenstaff Medical would not be able to offer me shifts until I can provide it *

Clear

Please confirm the date of signing: *

DD / MM / YYYY