SLIC Registration Form

SOUTHERN LIVE-IN CARERS Registration Form

Fill the form below accurately indicating your potentials and suitability for enrolment with us.
If you have any issues with completing the Registration Form please contact us by email at info@slic.services or phone 01458 527 201 and we can help you.
Your Name:*

First NameLast Name
Preferred name if different to birth name

First Name
Phone Number:*
E-mail Address:*
Your Address:*

Street Address

Street Address Line 2

CityState / Province

Post Code
How were you referred to us?*

SLIC Carer - If So Who?GoogleFacebookInstagramOther (please specify)
Carers Who Referred You or Others:
If you dont already have a UTR number, you will need to get one from HMRC

You will automatically be sent a Unique Taxpayer Reference (UTR) when you:

• Register for Self-Assessment (Self-Employed)

• Set up a limited company

It is a 10-digit number. It might just be called ‘tax reference’.

Where to find your UTR

Your UTR is on previous tax returns and other documents from HMRC, for example:

• Notices to file a return

• Payment reminders

You can also find your UTR in your Personal Tax Account if you are registered for Self-Assessment.
Your UTR Number:
Do you have a Full UK Driving Licence? *
Do you have a Full UK Driving Licence?

Yes - Full UKYes - Provisional OnlyYes - Non UK LicenceNo
Do you own your own car?
How many weeks on would you like to work?
How many weeks would you like off?
COVID VACCINATIONS

England’s health and social care secretary has announced that all staff who work in health and social care settings regulated by the Care Quality Commission will have to be fully vaccinated against COVID-19 by 1 April 2022.

You will need to supply us with proof of your COVID Vaccine Status. You can get a digital NHS COVID Pass through the NHS App or NHS website, using NHS login.

For help to access your COVID Pass please click here
Please select ONE of the following:

1st COVID Vaccine only1st & 2nd COVID Vaccine1st, 2nd & 3rd/Booster COVID VaccineNot currently COVID VaccinatedExempt from having the COVID vaccine's
Proof of Your COVID Vaccines

Upload A File

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Job Skills & Training
Describe your skills:*
Training or Certifications:
Please Upload All Training or Certifications that are still valid only:

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Care Certificate, NVQs, Manual Handling, Administration of Medication, Safeguarding, Fire Safety, Food Hygiene, First Aid, Mental Capacity, Health & Safety, Dementia Awareness etc Cancelof
Please add two (2) work / contractor references below. Please note this must include your most recent workplace / employer.
Reference 1
Name:*

First NameLast Name
Phone Number*

Country CodeArea CodePhone Number
Phone Number*
Email
example@example.com
Years Known:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Name:*

First NameLast Name
Phone Number*
Email
example@example.com
Years Known:*
Address

Street Address

Street Address Line 2

CityState / Province

PostCode
Character Reference

Please list a character references that have known you for minimum of 5 years.
Name:*

First NameLast Name
Phone Number*
Email
example@example.com
Years Known:*
Address

Street Address

Street Address Line 2

CityState / Province

PostCode
Your Proof of Address*

Upload A File

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Proof of ID Document*

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Proof of Right to Work in The UK

Please upload below one form of "your right to work in the UK" from the following:
- Normally British passport
- If you are a Commonwealth citizen and have a grandparent born in the UK you are entitled to an ancestral visa.
- Applications from those who are married to a member of an EEA national (spousal visa)
- Indefinite Leave to Remain
- Right of Abode
- have been granted asylum
- have qualified for a visa on the UK points-based system.
  
  Please note that we will need to see all original relevant work permits and Home Office letters before you are able to register with SLIC.
Right to work in UK ID Document*

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Right to work in UK Share code*

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Do you have your own Liability Insurance? *
Copy of Liability Insurance Certificate

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Only upload your DBS/CRB below if it's currently subscribed on the update service
DBS/CRB Certificate

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DECLARATION

I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement will be sufficient cause for rejection or, if contracted, termination of contract agreement.
Signature*

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Should be Empty:

SOUTHERN LIVE-IN CARERS Registration Form

Job Skills & Training

Reference 1

Reference 2