User Account Request Online Form

New User Account Request Form

To request an account, please fill in all the fields below marked 'required' and click submit. Your request will be processed by the support team who will shortly be in touch.

Subject (required)


Your Full Name: (required)


Work Sector: (required)
Select... Agency Charity / Voluntary College Emergency Services Health Housing Local Authority Nursing / Residential Homes Health - Primary Care Union University Welsh Government Other

Health Board/Trust: (required)
Select... Aneurin Bevan University Health Board Betsi Cadwaladr University Health Board Cardiff and Vale University Health Board Cwm Taf Morgannwg University Health Board DHCW First Responder HEIW Hywel Dda LLAIS NWSSP Powys Teaching Health Board Public Health Wales Swansea Bay University Health Board Velindre Velindre NHS Trust and Welsh Ambulance Service WAST

First Responder Role: (required)
Select... Community First Responder Community Welfare Responder Volunteer Car Driver

Service: (required)
Select... Dental GP Pharmacy Optician

Job Role: (required)


Practice Code: (required)


Practice Name: (required)

University: (required)
Select... Aberystwyth University Bangor University Cardiff University Cardiff Metropolitan University Open University Swansea University University of South Wales University of Wales Trinity Saint David Wrexham Glyndwr University

University Email address: (required)


Which Degree Scheme are you enrolled in? (required)


Which year of study are you enrolled in? (required)


Which sector does your study align with? (required)
Select... Allied Health Nursing and Midwifery Medical and Dental

You must complete one of the below: (required)
National Insurance Number (University Students Only)
Right to work Ref Number (International students only)
Residency Status (International students only)


Please enter the details for the above selection: (required)

Employers Name: (required)

Local Authority: (required)
Select... Anglesey Local Authority Blaenau Gwent Local Authority Bridgend Local Authority Caerphilly Local Authority Cardiff Local Authority Carmarthenshire Local Authority Ceredigion Local Authority Conwy Local Authority Denbighshire Local Authority Flintshire Local Authority Gwynedd Local Authority Monmouth Local Authority Merthyr Local Authority Neath Port Talbot Local Authority Newport Local Authority Pembrokeshire Local Authority Powys Local Authority Rhondda Cynon Taf Local Authority Swansea Local Authority Torfaen Local Authority Vale of Glamorgan Local Authority Wrexham Local Authority

Payroll Number: (required)

Union: (required)
Select... ASLEF BAOT BDA BECTU BFAWU BIOS BMA CSP CWU Equity FBA FDA GMB HCSA MU NAHT NASUWT NEU NUJ NUM PCS PFA POA Prospect RCM RCN RMT Royal College of Podiatry SoR TSSA UCAC UCU UNISON Unite URTU USDAW Wales TUC

Organisation: (required)

College: (required)
Select... Black Mountains College Bridgend College Busnes@LlandrilloMenai Cardiff and Vale College Coleg Cambria Coleg Ceredigion Coleg Cymraeg Cenedlaethol Coleg Gwent Coleg Sir Gâr Coleg y Cymoedd Gower College Swansea Grŵp Llandrillo Menai NPTC Group of Colleges Pembrokeshire College St David's Catholic College The College Merthyr Tydfil

Emergency Service: (required)
Select... Dyfed-Powys Police Gwent Police Mid and West Wales Fire and Rescue Service North Wales Fire and Rescue Service North Wales Police South Wales Fire and Rescue Service South Wales Police

Housing: (required)
Select... Adra Housing Aelwyd Housing Association Ateb Group Barcud Housing Bro Myrddin Housing Association Cadwyn Housing Association Cardiff Community Housing Association Caredig Ltd Cartrefi Conwy Charter Housing Association Clwyd Alyn Housing Association Coastal Group Community Housing Cymru Cynon Taf Housing Association Family Housing Association First Choice Housing Association Grwp Cynefin - Gwynedd Hafan Cymru Hafod Housing Hendre Group Melin Homes Merthyr Valleys Homes Mid Wales Neath Port Talbot Homes Newport City Homes Newydd Housing Association North Wales Housing Pobl Group Rhondda Housing Association Taff Housing Association Tai Calon Community Housing Tai Tarian Housing Trivalis Housing Association United Welsh Housing Association Wales & West Housing Association

Agency: (required)
Select... 247 Lifeline Ltd 9AND Limited T/A Nurses On Call ABILITY RECRUITMENT GROUP LTD Ace 24 Healthcare Ltd Ackerman Pierce Ltd AHE Services Limited Allied and Clinical Recruitments Alpha24 Healthcare Ltd Altrix Technology Ltd ASA Medical Solutions LTD Aspect Healthcare Ltd AUSTIN RESOURCES HEALTHCARE LTD Beacon Care Services Limited BECS UK Ltd Biggs Healthcare BlackRock Medical Recruitment Limited Bleep 360 Limited Bluelight Healthcare Recruitment Limited Bluerock Healthcare LTD Bluestones Medical CAMHS Professionals Canary Locums Care Crew Limited Care Providers recruitment Limited CareJoy Healthcare Limited Carepro LTD Castlerock Recruitment Group LTD CLINICAL EMPLOYMENT SERVICES LTD Concept Care Solutions Cromwell Medical Staffing CROWN MEDICAL SERVICES LIMITED Daytime Healthcare Recruitment Limited Direct Medics Ltd. Direct Nursing Services LTD DRC Locums LTD Eleventh Hour Group Endoglobal Limited Enferm Medical LTD Fine Care 24/7 Globe Locums Limited Goldstaff Recruitment Limited Hanson Grey Hays Specialist Recruitment Limited Healthcare Professionals Healthcare Recruiters Ltd Healthcare Staff Recruitment Limited HG Health Hoop Recruitment HSA LOCUMS LTD ICARE24 LIMITED ID Medical Group Limited IMC Locums Limited Immediate Medical Solutions Ltd Interact Medical LTD Jane Lewis JP MEDICALS RECRUITMENT LIMITED LAK Locums Limited Langley Clark Recruitment (LCR) Ltd Locum Placement Group Limited Locum Vision Limited Locumlinx Limited London Healthcare Locums Manuella Care LTD MBANDS LTD Med Pure Ltd Med Team Primary Care Services Medacs Healthcare PLC Medical 360 Limited Medical Prefessional Personnel Medical Staffing LTD Medical Station LTD Medical Wing Locums Medicspro LTD Medicure Professionals Ltd Medilink Consulting Limited Meditemp Limited Medlocums Recruitment LTD Medsol Healthcare Services LTD Minerva Nursing Limited Mofor Care Solutions MPS Healthcare MRecruiutment Limited MSI Recruitment LTD MSL Healthcare Mylocum LTD National Locums LTD NC Healthcare Ltd Next Step Developments Next Step Nursing Next Step Nursing Nos Da Healthcare Ltd NOVA HEALTH THERAPIES UK LTD OnCliniCall Limited One Call 24 Limited Pertemps Medical Professionals Primera Healthcare Pro Nursing Healthcare Procare Nursing LTD ProMedical Personnel Limited Proxycare PULSE healthcare Limited Quality Locum Solutions Limited Randstad Employment Bureau Ltd Rapid Prime Care Limited RAVEN MEDICAL STAFFING LIMITED Redspot Care Ltd Redspot Healthcare Solutions Retinue Solutions Limited Richmond Nursing Agency Ltd RMR Recruitment Limited Sanctuary Recruitment Ltd Sancuary Personnel Ltd Secure Healthcare Limited Sensecarelimited Sensible Staffing Ltd Seven Resourcing Severn Angels Healthcare Ltd Sirona Medical Limited Soleus People Ltd SOS Medical spectrumhealthcare domiciliary care Ltd SPRINGDAY HEALTHCARE Staffing Plus Ltd Staffing Professionals Limited Swiis Foster Care Ltd Tempcare 24 Limited TFS Healthcare The Flame Lily Healthcare Limited The Placement Group Healthcare Ltd TNA Medical Limited Total Assist Recruitment Total Staffing Solutions Ltd t/a Total Care Services Tripod Pertners TTM Healthcare Twenty Four Seven Recruitment (Yorkshire) Limited TXM Healthcare Limited Vetro Recruitment Ltd Vivid Executive Search WNA Healthcare Workforce Employment Solutions Limited Your World Recruitment Limited Other

National Insurance Number (format = AB 01 23 45 B): (required)

Other Agency: (required)

Name of Nursing/Residential Home: (required)

Please Select Your Work Sector With This List: (required)
Select... Adult Learning Wales Adnodd Cyfyngegid Amgueddfa Cymru - Museum Wales Arts Council of Wales Audit Wales Bannau Brycheiniog (Brecon Beacons National Park) Brecon Beacons National Park Authority CADW Welsh Historic Monuments Careers Wales Centre for Digital Public Services Llais Commission for Tertiary Education and Research Cwmni Egino Development Bank of Wales Development Trusts Association Wales Education Workforce Council Estyn Future Generations Commissioner Higher Education Funding Council for Wales Higher Education Purchasing Consortium (Wales) Life Sciences Hub Local Democracy & Boundary Commission Wales Mid Wales CJC National Dance Company National Library of Wales National Museums and Galleries of Wales Natural Resources Wales North Wales CJC Pembrokeshire Coast National Park Authority Qualifications Wales Older People's Commissioner for Wales Ombudsman for Wales Royal Commission on Historical and Ancient Monuments Wales Senedd Cymru Snowdonia National Park Authority Snowdonia National Park (Eryri) Social Care Wales South East Wales CJC South West Wales CJC Sport Wales Tovali LTD Transport for Wales Welsh Books Council Welsh Language Commissioner Welsh National Opera Welsh Revenue Authority Other - my organisation is not on this list

Employers Name: (required)

Other Work Sector: (required)

Job Title: (required)

Work Email Address: (If this is a generic email address, please add your personal email) (required)


Work Telephone Number (Format = 07888 222000): (required)


Employer's Address: (required)


Your Manager's Name: (required)

Your Professional Registration Body and Registration Number (i,e, GMC, NMC): (required)

Please provide information on where you have heard about this service: (required)


What courses do you need to complete? (required)


Do you work in the Welsh public sector? (required)
Select... Yes No

What services do you provide to Public Sector Wales? (required)


Please provide any additional information or instructions: (required)

Important -
You only need to submit one request for a new account to be processed. If multiple requests are submitted for the same user then this will result in a delay.