Skip to content
Home Link Logo
Your basket
24 Hour Advice Line
Donate
How we can help you
Care services
Get in touch with us
24/7 Support line
Email us
Make an enquiry
Make a complaint
What we do
Hospice services
Inpatient unit
Hospice at home
Day services
Support Groups
Support
24 Hour advice line
Making a referral
Family Stories
Bereavement support
Make a free Will
Education
The Education Team
Course Calendar
Project ECHO®
Placement Opportunities
Bespoke Training
Room Hire
How you can help us
Make a donation
Donate in memory
Leave a gift in your Will
Our shops
Play our Lottery
Fundraise for us
Events & Challenges
Volunteer
Make a Christmas Donation
Donate monthly
Register for Gift Aid
Make a donation
Create a Tribute page
Celebration tree
Funeral Collections
Shop finder
Shop online
Donate goods
Become a shop volunteer
Furniture collection service
Lottery Results Checker
Lottery Canvassers
Within your company
Within your school
Within your community
Fundraising guide
Meet our Benny Bear Mascot!
Our fundraising promise
Find an Event or Open Day
Open Gardens 2026
Take on a Challenge
Who we are
Latest news
Work for us
Management and trustees
Important information
History
Stay in touch
Visiting us
Contact us
Messenger Magazine Autumn/Winter '25
Messenger Spring/Summer '25
Messenger Magazine Autumn/Winter '24
Statement of purpose
Our fundraising promise
Environmental, Social and Governance (ESG) Standards
Complaints policy & procedure
Make a complaint
Give us your feedback
Search
Search
24 Hour Advice Line
Your basket
How we can help you
Care services
What we do
Hospice services
Inpatient unit
Hospice at home
Day services
Support Groups
Support
24 Hour advice line
Making a referral
Family Stories
Bereavement support
Make a free Will
Education
The Education Team
Course Calendar
Project ECHO®
Placement Opportunities
Bespoke Training
Room Hire
How you can help us
Make a donation
Make a Christmas Donation
Donate monthly
Register for Gift Aid
Donate in memory
Make a donation
Create a Tribute page
Celebration tree
Funeral Collections
Leave a gift in your Will
Our shops
Shop finder
Shop online
Donate goods
Become a shop volunteer
Furniture collection service
Play our Lottery
Lottery Results Checker
Lottery Canvassers
Fundraise for us
Within your company
Within your school
Within your community
Fundraising guide
Meet our Benny Bear Mascot!
Our fundraising promise
Events & Challenges
Find an Event or Open Day
Open Gardens 2026
Take on a Challenge
Volunteer
Who we are
Latest news
Messenger Magazine Autumn/Winter '25
Messenger Spring/Summer '25
Messenger Magazine Autumn/Winter '24
Work for us
Management and trustees
Important information
Statement of purpose
Our fundraising promise
Environmental, Social and Governance (ESG) Standards
Complaints policy & procedure
Make a complaint
Give us your feedback
History
Stay in touch
Visiting us
Contact us
Close modal
Search
Search
Spoke Placement Request
About You
Name
(Required)
First Name
Last Name
Date of Birth
(Required)
DD slash MM slash YYYY
Phone
(Required)
Email
(Required)
Enter Email
Confirm Email
Professional Status & Registration
Current Role
(Required)
Please select the appropriate option from the drop down menu.
Student
Registered Nurse / Midwife / Nursing Associate
Healthcare Assistant / Support Worker
Allied Health Professional
Medical Team
Course
(Required)
Please list the name of the course you’re currently enrolled on.
Year of Study
(Required)
Please enter a number from
1
to
4
.
Course Tutor / Placement Co-ordinator Name
(Required)
First Name
Last Name
Course Tutor / Placement Co-ordinator Email
(Required)
Enter Email
Confirm Email
Organisation Name
Organisation Address
Address Line 1
Address Line 2
Town/City
County
Postcode
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Are you Registered with a Professional Regulatory Body
(Required)
For example, The Nursing and Midwifery Council (NMC), Health and Care Professions Council (HCPC), General Medical Council (GMC).
Yes
No – If you don't hold a valid registration, we're unable to process this request. You're welcome to email us at education@smhospicehereford.org to discuss further.
Regulatory Body
(Required)
The Nursing and Midwifery Council (NMC)
The Health & Care Professions Council (HCPC)
The General Medical Council (GMC)
Registration / Pin Number
(Required)
Consent
(Required)
If you are registered to a regulatory body and consent to us verifying your registration status, please tick the box provided below.
I consent to St Michael’s verifying my registration status with the relevant regulator.
DBS (Disclosure and Barring Service) Check
As part of our safeguarding responsibilities, all individuals attending placement within the Hospice must hold an appropriate DBS check.
Do you hold a current and valid DBS certificate?
(Required)
Yes
No
DBS Certificate Issued
(Required)
DD slash MM slash YYYY
Does your DBS include a Barred List check?
(Required)
Yes
No
DBS Certificate Type
(Required)
Basic
Standard
Enhanced – Required for patient-facing roles
DBS Certificate Number
(Required)
Are you registered with the DBS Update Service?
(Required)
Yes
No
Consent
If you are registered with the DBS Update Service and consent to us carrying out an online status check, please tick the box provided below.
I am registered with the DBS Update Service and consent to St Michael’s completing an online status check.
Availability
Please indicate your preferred dates for placement, and we will try our best to accommodate.
Preferred Date 1
(Required)
DD slash MM slash YYYY
Preferred Date 2
(Required)
DD slash MM slash YYYY
Preferred Department
Please select which department(s) you are interested in completing your spoke placement with.
Departments
(Required)
Day Services
Hospice at Home
In-Patient Unit (IPU)
Medical Team
Therapies – Physiotherapy & Occupational Therapy
Select All
Learning & Career Aspirations
Please answer the following. If your application is successful, this information will help us tailor your placement to your personal aims and objectives.
Please tell us why you are interested in completing a spoke placement at St Michael's Hospice
(Required)
What learning outcomes would you like to achieve during your placement with us? How will this placement benefit your current studies and career aspirations?
Health Declaration
We want to ensure that any placement offered is safe for you. Please disclose any health conditions or disabilities that may affect your ability to carry out key duties. Where possible, reasonable adjustments will be considered, and we may request further information to ensure the placement is suitable for you.
Do you have any health conditions or disabilities that we should be aware of to support you in this role?
(Required)
Yes
No
If yes, please provide details below
Emergency Contact Details
Please provide the contact details of your emergency next of kin – ensuring you have gained permission to share their details.
Emergency Contact Name
(Required)
First Name
Last Name
Relationship to Yourself
(Required)
Phone Number
(Required)
Email
(Required)
Declaration
I declare
(Required)
I will hold in strict confidence any personal information concerning patients, their families or staff members which may become know to me during the exercise of my duties in any of the establishments of the St Michael’s Hospice. I understand that the use of mobile devices in clinical areas is not permitted. I will not divulge confidential or personal information to any unauthorised person and not discuss in any public place. I understand that such confidential or personal information includes both clinical and non-clinical information. I understand also that the disclosure to unauthorised persons of confidential information as detailed above is classified within the disciplinary rules as conduct which may warrant further action. I understand I must not disclose my personal details, address, phone number, social media account etc to patients or families.
I declare that
(Required)
To the best of my knowledge, the information I have given on this form is true and accurate. Understanding that any false claim may result in my application being refused or my placement being cancelled. I understand that my personal details will be held on Hospice systems for the purposes of communication, in accordance with UK General Data Protection (GDPR).