Care Professional Register
Registration Form (Self 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
How Do You Identify As Self Employed?
*
Sole Trader
Self Employed
Micro Provider
Personal Assistant
Personal Support Worker
Personal Care Worker
Independent Care Worker
Other
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 Liability Insurance Certificate
*
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Choose a file
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Please Upload a Copy of your Enhanced DBS Certificate
*
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Choose a file
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Please Upload a Copy of your Care Certificate if Applicable
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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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of
Please Upload Copies of your Policies & Procedures
*
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Privacy Policy, Safeguarding Policy, Complaints Procedure
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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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