I declare that the information I have given on this form is correct and complete and that I have not claimed elsewhere for
the hours/shifts detailed on this timesheet. I understand that if I knowingly provide false information this may result in
disciplinary action and I may be liable to persecution and civil recovery proceedings. I consent to the disclosure of
information from this form to and by the Authority, other Public Sector body and private entities who have a similar
requirement and the Counter Fraud Services (or other similar organisation which operates in the same capacity for any
other Public Sector organisation) for the purpose of verification of this claim and the investigation,
prevention, detection, and prosecution of fraud). I confirm that Induction and orientation was given at the beginning of
the placement.

I am an authorised signatory for my Ward/Department/NHS/Public sector body/Private sector body. I am signing to confirm that the Job profile Title and
Band/Grade of Temporary Workers and the hours/shift that I am authorising are accurate and I approve payment. I understand that if I knowingly provide false
information this may result in disciplinary action and I may be liable to prosecution and civil recovery proceedings. I consent to the disclosure of information
from this form to and by the Authority, other Public Sector body and private entities who have a similar requirement and the Counter Fraud Services (or other
similar organisation which operates in the same capacity for any other Public Sector organisation) for the purpose of verification of this claim and the
investigation, prevention, detection, and prosecution of fraud). Any questionable timesheets must be immediately brought to the attention of the Local Counter
Fraud Specialist (withing England) or you may have to report any case of fraud, in confidence, to the NHS/Crimestoppers Fraud and Corruption Reporting Line –
on 0800 028 4060 I confirm that Induction and orientation was given at the beginning of the placement.