MakCare Connect – Carer Registration Form Helping care seekers choose the right carer with confidence and clarity. 1. Personal InformationFirst Name GenderMaleFemalePhone Number Address Languages SpokenAfarAbkhazianAvestanAfrikaansAkanAmharicAragoneseArabicAssameseAvaricAymaraAzerbaijaniBashkirBelarusianBulgarianBihariBislamaBambaraBengaliTibetanBretonBosnianCatalanChechenChamorroCorsicanCreeCzechChurch SlavicChuvashWelshDanishGermanDivehiDzongkhaEweGreekEnglishEsperantoSpanishEstonianBasquePersianFulahFinnishFijianFaroeseFrenchWestern FrisianIrishScottish GaelicGalicianGuaraniGujaratiManxHausaHebrewHindiHiri MotuCroatianHaitianHungarianArmenianHereroInterlingua (International Auxiliary Language Association)IndonesianInterlingueIgboSichuan YiInupiaqIdoIcelandicItalianInuktitutJapaneseJavaneseKartuliKongoKikuyuKwanyamaKazakhKalaallisutKhmerKannadaKoreanKanuriKashmiriKurdishKomiCornishKirghizLatinLuxembourgishGandaLimburgishLingalaLaoLithuanianLuba-KatangaLatvianMalagasyMarshalleseMaoriMacedonianMalayalamMongolianMarathiMalayMalteseBurmeseNauruNorwegian BokmalNorth NdebeleNepaliNdongaDutchNorwegian NynorskNorwegianSouth NdebeleNavajoChichewaOccitanOjibwaOromoOriyaOssetianPanjabiPaliPolishPashtoPortugueseQuechuaRaeto-RomanceKirundiRomanianRussianKinyarwandaSanskritSardinianSindhiNorthern SamiSangoSinhalaSlovakSlovenianSamoanShonaSomaliAlbanianSerbianSwatiSouthern SothoSundaneseSwedishSwahiliTamilTeluguTajikThaiTigrinyaTurkmenTagalogTswanaTongaTurkishTsongaTatarTwiTahitianUighurUkrainianUrduUzbekVendaVietnameseVolapukWalloonWolofXhosaYiddishYorubaZhuangChineseZuluDo You Own a Car?YesNoLast Name Birth Date Email Address Postal Code Do you hold a valid UK driving licence?YesNo2. AvailabilityAvailabilityFull-timePart-timeLive-in CareHourly CareOvernight/Sleep-inEmergency CoverPreferred Days & Hours: 3. Experience & QualificationsYears of Care Experience: Previous Job Roles or Care Settings (tick all that apply):Domiciliary CareResidential/Nursing HomeLive-in CareHospitalLearning Disabilities SupportPrivate Clientothers Specialist Experience With (tick all that apply):DementiaPalliative/End-of-LifeStrokeAutism / Learning DisabilitiesCatheter/Stoma CareHoisting / Mobility AidsPEG Feeding / TracheostomyChild/Young Adult CareMental Health SupportRelevant Qualifications or Training CertificatesCare CertificateNVQ/Diploma in Health & Social CareManual HandlingMedication AdministrationFirst AidSafeguardingothers 4. DBS & InsuranceDo you have a valid Enhanced DBS certificate?YesNoIs it on the Update Service? IssueDateYesNoDo you have Public Liability Insurance?YesNo5. Hourly Rate & ServicesPreferred Hourly Rate (£): Live-in Daily Rate (if applicable): Do you accept private clients, direct payments, or both?PrivateDirect PaymentBothServices You Provide (tick all that apply):Personal Care (e.g., washing, toileting)CompanionshipMeal PreparationLight HousekeepingMedication SupportMobility AssistanceShopping & ErrandsEscort to AppointmentsComplex Care Tasks (specify): _______6. Profile Summary / Personal StatementA short paragraph about who you are, your care approach, and why families should choose you (100–150 words):7. Upload DocumentsUpload scanned copies or photosUpload Upload scanned copies or photosUploadYou may be asked to upload scanned copies or photosEnhanced DBS CertificateProof of IDProof of AddressInsurance CertificateTraining CertificatesProfile Photo (for your listing)8. References (Optional)Name of Reference 1 Relationship Contact Name of Reference 2 Relationship Contact Only fill in if you are not human Login
