Staff Lottery Application Form

Complete the below form to join our Staff Lottery!

How to save the Staff Benefits and Wellbeing section to your home screen

iPad or iPhone

Launch “Safari” app.
Enter into the address field the URL of the website you want to create a shortcut to. Tap “Go.”
Tap the icon featuring a right-pointing arrow coming out of a box along the top of the Safari window to open a drop-down menu.
Tap “Add to Home Screen.” The Add to Home dialog box will appear, with the icon that will be used for this website on the left side of the dialog box.
Enter the name for the shortcut using the on-screen keyboard and tap “Add.” Safari will close automatically and you will be taken to where the icon is located on your iPad’s desktop.

Android

Launch “Chrome” app.
Open this link.
Tap the menu icon (3 dots in upper right-hand corner) and tap Add to homescreen.
You’ll be able to enter a name for the shortcut and then Chrome will add it to your home screen.

About You

Title*

Full name (including middle names)*

Job Role*

Department *

Phone Number*

Work Address

You must include your department, area and site (e.g. Staff Benefits, Park House, York Hospital). This is the address we will post your lottery card and welcome letter too, if the address is incomplete you will not receive it*

Assignment Number (found on your wage slip)*

Work email (must end in @nhs.net)

We contact all winners via their @nhs.net email. If you do not have an @nhs.net email, please speak to your line manager to obtain one*

Employed by (please select)

**If you hold a bank only contract, you will be unable to join the staff lottery as it is not possible for us to set up deductions from your wage.

Membership

Please complete either Part A or Part B

Part A

I am not a member of the lottery but I want to join

Please select the amount of numbers you'd like on the lottery (£2 per number per month)

Part B

I am already a member of the lottery but want extra numbers

Number of numbers already held

Number of additional numbers required (not including already held)

Declaration

I authorise the deduction of lottery entry fees from my salary with effect from the month prior to my number(s) being entered into the draw following receipt of this form by the lottery office, until cancelled by me in writing or until the termination of my employment with York and Scarborough Teaching Hospitals NHS Foundation Trust or LLP. I acknowledge that I have read and understand the York Teaching Hospitals Foundation Trust staff lottery rules.**

Are you happy for your name to be used in the winners list should you be lucky enough to win*

Please note: All new members will receive their staff lottery cards between 4 -6 weeks of the application being made. If you have still not received your Staff Lottery card after 6 weeks of your application being made, please email yhs-tr.staffbenefits@nhs.net

* required fields