Barcode Number (Library Use Only)

PLEASE PRINT CLEARLY

Barcode Number (Library Use only) SMC______

Mrs/Miss/Ms/Dr/Mr Male/Female Forename Surname

Job Title Ward / Department / University*

Employer Bleep Work phone

Preferred email address:

Southend Hospital  (please tick) / other Work address

Current home address / Hospital accommodation address

Mobile no:

Postcode: Home phone no:

Permanent address (if different from above)

Postcode:

Leaving date / End of placement date:

*Students - Manager/Mentor name:

SEPT Manager name and email/telephone: I consent to the data above being used in accordance with the Data Protection Act. I agree to abide by the Library Membership Rules and Regulations. (Next Page)

Signed: Date: Library Membership Rules and Regulations

Registration You must register with the library, provide proof of identity and your placement dates in the hospital if you are on a University course. It is your responsibility to notify us of any change to your personal details. Membership cards and PIN numbers are not transferable and you should bring your card with you when you want to borrow books.

University students While students are on placement at Southend University Hospital NHS Foundation Trust they will be granted temporary library membership for the duration of the placement. At all other times students should use their university or college library as their main library.

Overdue/lost/damaged books Recall notices will be emailed to you for overdue books, and fines will be charged at 10p per item, per day. After three recall notices, an invoice will be issued and a letter sent to your manager and/or University. If books are lost/damaged or not returned, an invoice or deduction from salary will be issued for the full replacement cost, plus any administrative charges where applicable. Library membership will be suspended until books are returned or payment is received. A second suspension will result in library membership being withdrawn for at least one year.

Book renewals Books are normally issued for 21 days, although in demand books are 7 day loans and they can only be renewed by you up to three times and must be brought back to the library for further renewal. If a book is requested by another borrower you must return it.

Journals, photocopying and printing Journals are not available for loan. You must comply with the Copyright Designs and Patent Act 1988, EU Copyright Directive and NHS Copyright Licensing Agency agreement if your copying is for private study or non-commercial research.

Computers and internet You must agree to comply with the Southend University Hospital NHS Foundation Trust Information Security and Internet Access Policies. It is your responsibility to ensure that you also comply with Copyright and Privacy Regulations.

Environment and security Noise should be kept to a minimum in all areas. Library staff cannot be held responsible for any personal property left in the library. All personal belongings should be removed when leaving the library or stored within the lockers provided.