Staff Registration

Staff Registration

Please complete the following to register with First Line Response. You may save your progress to complete later by clicking the SAVE button at any time. It's important that you allow time for the documents to upload, please be patient if there is a delay in allowing you to proceed.
Profile photo
Name*

First NameLast Name
DOB*

DayMonthYear
Email*
example@example.com
Mob Number
Address

Street Address

Street Address Line 2

CityCounty

Postal code
CV

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NOK Name:*

First NameLast Name
NOK Contact Number:*
Polo shirt size:*
e.g. XS, S, M, L, XL, XXL, 8, 10, 12
On occasion, due to logistics, there may be times where it would help to have your own equipment. We would need verification that it is calibrated / certificated as appropriate so please only list kit where this is appropriate.
What equipment do you have (as applicable)?

Response Bag (as per scope of practice)OxygenAEDMedicinesControlled Drugs (Morphine / Diazepam)

Right to Work evidence

Please provide evidence of your right to work by uploading a copy of your passport. The responsibility of TAX and NI contributions is retained by you the contractor, with monies due only paid on receipt of a valid invoice.
I would like to register for the following role(s):*

Medical TeamInstructor/Assessor/IQA
Legal status*

Sole trader (self employed)Limited Company
Company registered name:
Company number:
Legally registered address (as listed on companies house)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Insurance Documentation

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NI Number:
Passport Number:
Copy of Passport*

Please upload a copy of the photo page
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Proof of Address*

Dated within 3 months of application e.g. utility bill, council tax
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Instructor/Assessor/IQA Qualifications

Please provide details on your educator qualifications. Please ensure that appropriate certificates are uploaded for the roles selected.
Please register me for the following role(s):

InstructorAssessorIQA
Certificate(s)

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Driving License
Please provide details of your driving qualifications.
Driving License Number
LAST 8 CHARACTERS ONLY. For example, 192GT2BD
Copy of driving license

Please ensure both sides of the driving license are uploaded
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Do you hold an emergency driving qualification?

YESNO
Emergency Driving Certificate

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DBS
Certificate Number*
Copy of Enhanced DBS Certificate*

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I give permission for First Line Response Limited to retain a copy of my original DBS certificate for verification purposes.*

YESNO
I confirm I have an active subscription to the DBS update service and that First Line Response Limited may complete an annual check for updates in relation to the verified certificate.*

YESNO

Other Evidence

Please upload any other documentation including CPD Certificates, CPD Plans or supporting evidence.
Other Certificates

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References

Please provide details of 2 referees (a minimum of 1 employer within the last 2 years)
Referee 1
Referee 2
Name (1)

First NameLast Name
Name (2)

First NameLast Name
Email (1)
example@example.com
Email (2)
example@example.com
By signing this form, I understand that the information and documentation provided will be retained by First Line Response for the purposes of compliance and that documentation and contact details may be provided to clients as necessary to support service provision and audits as required.
Signature

Clear
Please verify that you are human*
Date

DayMonthYear
Date
Should be Empty:

Right to Work evidence