UCL AGENCY BOOKING FORM Section A: Job details: Job Title: Reporting to: Contact details for booking: Name: Telephone number: Location of booking:: Start: date of booking: End date of booking: Hourly rate of pay: Rate of pay: UCL Grade: Section B: Role duties and experience Purpose of role: Main Duties Qualifications required: University College London Gower Street London WC1E 6BT Page 1 of 2 Spine point: Experience required: Special Working Conditions (including any health and safety risks): Section C : Payment of invoices The purchase order number: The timesheets to be approved by: Departmental contact for invoice payment: Name: Telephone number: Section D : Other The agency worker will carry out any other duties as are within the scope, spirit and purpose of the job as requested by the line manager or Head of Department/Division The agency worker is expected to comply with UCL policies including Equal Opportunities policies The agency worker will maintain an awareness and observation of Fire and Health & Safety Regulations Completed by: University College London Gower Street London WC1E 6BT Date: Page 2 of 2