Registration – Simply My Care

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Registration Form

Step 1 of 3

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Role I am applying for(Required)

Select one from the drop down

Personal Details

First Name as seen on Valid ID(Required)

Last Name as seen on Valid ID(Required)

Title(Required)

Date of Birth(Required)

Nationality(Required)

Do you hold a current UK driving licence?(Required)

Yes

Contact Details

Address(Required)

Postcode(Required)

Contact number(Required)

Email(Required)

Non EC Nationals only

Are you a non EU National?(Required)

Yes

Do you require a work permit?(Required)

Yes

Have you ever been the subject of complaint, dismissal or disciplinary action?

Yes

Employment History (Where applicable please give details of your last 3 jobs:)

Employment 1

Company Name(Required)

Contact Name(Required)

Date From (DD/MM/YYYY)(Required)

Date To (DD/MM/YYYY)(Required)

Job Title(Required)

Telephone Number(Required)

Address(Required)

Main Duties(Required)

Reason for leaving(Required)

Employment 2

Job Title

Date From (DD/MM/YYYY)(Required)

Date To (DD/MM/YYYY)(Required)

Company Name(Required)

Contact Name(Required)

Telephone Number(Required)

Address(Required)

Main Duties(Required)

Reason for leaving(Required)

Employment 3

Job Title

Date From (DD/MM/YYYY)(Required)

Date To (DD/MM/YYYY)(Required)

Company Name(Required)

Contact Name(Required)

Telephone Number(Required)

Address(Required)

Main Duties

Reason for leaving

References

We will be taking up references covering a minimum of 3 years. One reference will normally be from your previous/current employer. College/university leavers should give the name of their lecturers/tutors/professors. Please note, friends and relatives do not qualify as suitable referees. Please provide referees below, including your most recent employer, covering a 3 year period

Reference 1

Contact Name(Required)

Company Name(Required)

Date From (DD/MM/YYYY)(Required)

Date To (DD/MM/YYYY)(Required)

Telephone Number(Required)

Enter international format

Email(Required)

Reference 2

Company Name(Required)

Contact Name(Required)

Date From (DD/MM/YYYY)(Required)

Date To (DD/MM/YYYY)(Required)

Telephone Number(Required)

Enter international format

Email(Required)

Contact person's role

Reference 3

Company Name

Contact Name

Contact person's role

Date From (DD/MM/YYYY)

Date To (DD/MM/YYYY)

Telephone Number

Enter international format.

In what capacity is this person known to you? (e.g. previous employer, college tutor)

Finalise Registration

Attach CV

Max. file size: 128 MB.

Attach Copy of ID

Max. file size: 128 MB.

Attach 2nd copy of ID/Right to work

Max. file size: 128 MB.

example:

Attach Copy of DBS

Max. file size: 128 MB.

Attach Proof of address

Max. file size: 128 MB.

Attach second proof of address

Max. file size: 128 MB.

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