Care Professional Register
Registration Form (Directly Employed)
Personal Details
Profile Photo
*
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Postal Code
Email
*
Mobile Phone Number
*
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Employment Details
How Long Have You Worked in Social Care?
Just started
Less than a year
Less than 2 years
2 years or more
What is your Job Title?
Care Assistant
Care Worker
Support Worker
Enablement Worker
Personal Assistant
Live In Care Worker
Other
Employment Status
Full Time
Part Time
Bank
Have You Completed Your Mandatory Training?
Yes
No
Have You Been Enrolled/Completed the Care Certificate?
Yes
No
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Verification Documents
These are required to validate your registration
Please Upload a Copy of your Enhanced DBS Certificate
*
Browse Files
Drag and drop files here
Choose a file
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of
Please Upload a Copy of your Care Certificate if Applicable
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Choose a file
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of
Please Upload Copies of your Training Certificates
*
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Choose a file
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of
Please Upload Copies of any Social Care Qualifications
*
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Choose a file
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of
Signature
I confirm that to the best of my knowledge that the information provided on this form is accurate.
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Payment Details
CPR Registration Fee
*
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( X )
Registration Fee (Monthly)
£
2.00
Quantity
1
2
3
4
5
6
7
8
9
10
Registration Fee (Annual)
£
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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