Online Registration Form
We now have this new online registration process. It is very easy to use and simple to follow. If you have any difficulties you can simply contact us and we can help you through this. It is important that you provide all the information to make your Registration happen as quickly and as accurately as possible. After completing this registration form, you will be required to take your documents to your nearest ID checking Facility ( a link will be given when you complete this form on your confirmation email so that you can see where the nearest office is to you. This list can be found on our website www.lastminutenursing.com on the "Our Locations" page ).

Please note that if you do not have at least 6 months experience in a nursing home that we can evidence with a reference you will not be able to register with this agency. You must be familiar with the systems, procedures and day to day tasks in a residential service. There are exceptions for staff that have significant experience and training in personal care, hoists and other forms of care in the community but you must call the office to gain advise before completing this registration process.

How did you hear about us? *
please help us understand how our marketing is working
About You
Full Name *
Your answer
Date Of Birth *
Your answer
National Insurance Number *
Your answer
Do you drive *
Your Nearest Lastminute Care & Nursing Office *
Please select which office will be your nearest office to attend with your ID Documents
Do you have a DBS on the Online Update Service, or a DBS processed in the last 3 months? *
Male Workers
Uniform Size Males
Female Workers
Uniform Size Females
What Grade of staff are you *
Please select the nearest relevant staff grade. Please only select the relevant grade nd do not select your
Nursing PIN Number with NMC if applicable
Your answer
Are there any restrictions on your registration with NMC
Please only answer if you are a Qualified Nurse
Sex ( M / F ) *
Your answer
Nationality *
Your answer
Mobile Number *
Your answer
Email Address *
Please triple check this, we will email you on how to complete your ID checking process.
Your answer
Home Number or Secondary Contact Number *
Your answer
Full Current Address
House name / number *
Your answer
Street Name *
Your answer
City *
Your answer
Postcode *
Your answer
Previous Address History
Please provide the details below of any previous addresses so that we have 5 years history with no gaps. This is necessary for all staff even if the previous address was in a different country.
Previous Address 1
Your answer
Dates you were at this address
Please provide month and year of residence. for example 02/2014 - 04/2015
Your answer
Previous Address 2
Your answer
Dates you were at this address
Please provide month and year of residence. for example 02/2014 - 04/2015
Your answer
Previous Address 3
Your answer
Dates you were at this address
Please provide month and year of residence. for example 02/2014 - 04/2015
Your answer
Previous Address 4
Your answer
Dates you were at this address
Please provide month and year of residence. for example 02/2014 - 04/2015
Your answer
Payment Details
This is very important to ensure we get you on the correct Tax Code, and that we pay you into the correct bank account too!

If you are not happy to provide these details at this stage then that is fine just leave this section blank until your registration is complete and you are ready to start working with us and we will update your records then.

Please select how you are paid below: *
HMRC Declaration *
This will dictate your Tax Code so please read the following properly
Employment History
Please province the following information regarding your most recent employment.
Name Of Employer *
Your answer
Approximate length of service at this employer *
Your answer
Job Title at this employer
Your answer
A brief description of duties and responsibilities
Your answer
Overall Experience in the care sector
please tell us a little about your experience and abilities
How many years experience do you have in the care sector *
Your answer
Have you got experience using Hoists and with Personal Care *
Your answer
Have you worked for an organisation and have you covered basic mandatory training in the last 12 months *
Required
Please select the following relevant fields to inform us of your experience *
Required
That's everything we need!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service