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Live In Care Job Registration Form

    Please complete this confidential application form as fully as possible in order that the information may be entered into our secure database

    Work Preferences









    Personal Details


















    YesNo

    YesNo

    Enhanced DBS Certificate




    YesNo

    Previous Work Experience

    Experience 1


    From: To:

    YesNo










    Experience 2


    From: To:

    YesNo










    Knowledge, Skills and Experience

    I have the following care skills, care qualification and care experience. Please select all the relevant boxes that apply (Proof maybe required)


    AspergersBehaviours That ChallengeCancer CareCatheter CareCOSHH TrainingDementia (Alzheimer, Vascular)End of life / Palliative CareEpilepsy / Buccal midazolamIncontinenceLearning Disability (Autism, Down Syndrome etc)Manual HandlingMedication TrainingMental Health (Schizophrenia, Depression, Bi-Polar)Multiple SclerosisOlder PeoplePalliative Care (Cancer, Brain Tumours, End Of Life)Parkinson’sPeg FeedingPersonal CarePhysical DisabilitiesSensory Disabilities (Blind / Deaf)Spinal InjuryStomaStroke / Brain InjuryTracheostomy

    MedicalNursingNVQ Health and Social CareOccupational TherapyThe Care CertificateNo Care Qualifications

    Care for close relative or loved oneHome CareLive in care workOther Care Work

    Very BasicConversationalFluent

    DECLARATION AND CONSENT

    I confirm that the information disclosed in this application form is relevant and correct and can be verified by references from previous employers and/or any professional bodies specified. I understand that information I have disclosed to be held within a secure computer database.

    I hereby give my FULL CONSENT for information I have disclosed to be divulged to companies or agents as deemed necessary by Live In Care in relation to my application for work including references.

    Pursuant to the Rehabilitation of Offenders Act, I declare that I have no unspent convictions and there are no prosecutions pending at this time. I also undertake to inform Live In Care of any prosecution that occurs whilst my details are held by Live In Care.
    Whilst on assignment from Live In Care I will regard all available information as confidential and I will not divulge it to any third parties plus I will comply to the Health & Safety regulations of all the service users I am assigned to. I confirm that I have applied / re-applied to Live In Care of my own free will and have not been offered any inducement to do so.

    Please note that Live In Care will be in touch after you submit this application form.




    There is a bit of a time delay when you submit this form. Click ‘Submit’ and then wait until you see the message saying that it has been submitted. There is no need to click submit multiple times.

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    Live In Care Areas That We Cover

    UK Areas:

    Live In Care Job Registration Form Berkshire

    Live In Care Job Registration Form Berkshire

    Live In Care Job Registration Form Berkshire from Bracknell to Reading, Slough to Windsor and Wokingham to Newbury

    Live In Care Job Registration Form Bristol

    Live In Care Job Registration Form Bristol

    Live In Care Job Registration Form Bristol, from Ashley to Bishopston, Cabot to Easton and Hillfields to Lawrence Hill

    Live In Care Job Registration Form Cornwall

    Live In Care Job Registration Form Cornwall

    Live In Care Job Registration Form Cornwall, from Penzance to Bodmin, Newquay to St Austell and Truro to Camborne

    Live In Care Job Registration Form Devon

    Live In Care Job Registration Form Devon

    Live In Care Job Registration Form Devon, from Plymouth to Paignton, Exeter to Exmouth and Torquay to Tiverton

    Live In Care Job Registration Form Dorset

    Live In Care Job Registration Form Dorset<

    Live In Care Job Registration Form Dorset, Bournemouth to Bridport, Poole to Portland and Dorchester to Christchurch

    Live In Care Job Registration Form Gloucestershire

    Live In Care Job Registration Form Gloucestershire

    Live In Care Job Registration Form Gloucestershire, from Cheltenham to Stroud, Gloucester to Tewkesbury and Cirencester to Dursley

    Live In Care Job Registration Form Hampshire

    Live In Care Job Registration Form Hampshire

    Live In Care Job Registration Form Hampshire, from Ringwood to Basingstoke, The New Forest to Portsmouth and Winchester to Southampton

    Live In Care Job Registration Form Herefordshire

    Live In Care Job Registration Form Herefordshire

    Live In Care Job Registration Form Herefordshire, from Hereford to Leominster, Ledbury to Bromyard and Kington to Credenhill

    Live In Care Job Registration Form London

    Live In Care Job Registration Form London

    Live In Care Job Registration Form London from Croydon to Barnet, Newham to Ealing and Enfield to Bromley

    Live In Care Job Registration Form Oxfordshire

    Live In Care Job Registration Form Oxfordshire

    Live In Care Job Registration Form Oxfordshire, from Banbury to Oxford, Bicester to Didcot and Witney to Abingdon

    Live In Care Job Registration Form Shropshire

    Live In Care Job Registration Form Shropshire

    Live In Care Job Registration Form Shropshire, from Telford to Shrewsbury, Oswestry to Bridgnorth and Newport to Ludlow

    Live In Care Job Registration Form Somerset

    Live In Care Job Registration Form Somerset

    Live In Care Job Registration Form Somerset, from Bath to Bridgwater, Chard to Minehead and Taunton to Yeovil

    Live In Care Job Registration Form Surrey

    Live In Care Job Registration Form Surrey

    Live In Care Job Registration Form Surrey from Camberley to Dorking, Egham to Epsom and Farnham to Guildford

    Live In Care Job Registration Form Warwickshire

    Live In Care Job Registration Form Warwickshire

    Live In Care Job Registration Form Warwickshire, from Nuneaton to Rugby, Royal Leamington Spa to Warwick and Bedworth to Stratford-upon-Avon

    Live In Care Job Registration Form West Midlands

    Live In Care Job Registration Form West Midlands

    Live In Care Job Registration Form West Midlands, from Birmingham to Coventry, Dudley to Sutton Coldfield and Walsall to Wolverhampton

    Live In Care Job Registration Form Wiltshire

    Live In Care Job Registration Form Wiltshire

    Live In Care Job Registration Form Wiltshire, from Swindon to Melksham, Salisbury to Trowbridge and Chippenham to Amesbury

    Live In Care Job Registration Form Worcestershire

    Live In Care Job Registration Form Worcestershire

    Live In Care Job Registration Form Worcestershire, from Worcester to Redditch, Kidderminster to Malvern and Bromsgrove to Evesham

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