Application Form | YouChooseCare

Self-Employed Domiciliary Care Worker
Application Form

Understanding Our Relationship

Thank you for your interest in working with Youchoosecare Ltd. Please read the following carefully before proceeding with your application.

Youchoosecare operates as an introductory agency. This means we connect self-employed care workers (you) with clients who need care services. It is critical to understand the following:

You are not an employee of Youchoosecare.
You operate as an independent business (sole trader or limited company).
You are responsible for your own taxes, National Insurance, and pension contributions.
You are expected to have your own Public Liability and Professional Indemnity Insurance.
We do not control how you perform your work, only that it meets the professional standards and clients care plans we agree upon.

By proceeding with this application, you confirm you understand and accept this business relationship.

I have read, understood, and accept the above terms.

I have read, understood, and accept the

above terms.

Personal Details

First Name

Surname

Gender

Male

Female

Non-binary

Prefer not to say

Date of Birth

Phone Number

Email Address

Right to Work & Identification

Do you have the legal right to work in the UK?

Do you have the legal right to work in

the UK?

Yes

National Insurance Number

Share Code (if applicable)

Self-Employment Status

Are you currently registered as self-employed with HMRC?

Are you currently registered as

self-employed with HMRC?

Yes

If not, are you willing to register?

Yes

Do you hold Public Liability Insurance?

Yes

Willing to obtain

Care Experience

Do you have previous experience working in domiciliary care, residential care, or a similar role?

Do you have previous experience

working in domiciliary care, residential

care, or a similar role?

Yes

If yes, please describe your experience

How many years of care experience do you have?

How many years of care experience

do you have?

0-1

2-5

Have you worked with any of the following client groups? (tick all that apply)

Have you worked with any of the

following client groups?

(tick all that apply)

Do you hold any relevant qualifications (e.g. NVQ/QCF in Health & Social Care)?

Do you hold any relevant qualifications

(e.g. NVQ/QCF in Health &

Social Care)?

Yes

If yes, please specify

Training & Compliance

Do you have up-to-date mandatory care training (e.g. safeguarding, moving & handling, etc?

Do you have up-to-date mandatory

care training (e.g. safeguarding,

moving & handling, etc?

Yes

Willing to obtain

If yes, are you able to provide copies of your valid certificates when requested?

If yes, are you able to provide copies

of your valid certificates when

requested?

Yes

Do you hold a valid Enhanced DBS certificate?

Do you hold a valid Enhanced

DBS certificate?

Yes

Willing to obtain

Are you registered on the DBS Update Service?

Are you registered on the DBS

Update Service?

Yes

If yes, are you able to provide your DBS certificate number at a later stage?

If yes, are you able to provide your

DBS certificate number at a later stage?

Yes

Availability & Flexibility

What type of hours are you available for? (tick all that apply)

What type of hours are you available

for? (tick all that apply)

How many hours per week are you looking to work?

How many hours per week are you

looking to work?

Are you able to travel between clients’ homes?

Are you able to travel between

clients’ homes?

Yes

Do you hold a full UK driving licence?

Yes

Bonus (Optional but Useful)

Why do you want to work as a self-employed domiciliary care worker?

Why do you want to work as a

self-employed domiciliary care worker?

What makes you a good fit for this role?

Declaration & Consent

Please read the following statements carefully and provide your electronic consent by checking the boxes and typing your name below.

I confirm that the information I have provided in this application is true, accurate, and complete to the best

of my knowledge. I understand that providing false information could lead to the immediate termination

of any agreement with Youchoosecare Ltd.

I confirm that the information I have provided in

this application is true, accurate, and complete

to the best of my knowledge. I understand that

providing false information could lead to the

immediate termination of any agreement

with Youchoosecare Ltd.

I understand and agree that my relationship with Youchoosecare Ltd is that of an independent, self-employed

contractor and not an employee. I am solely responsible for my own income tax, National Insurance, and other

statutory obligations.

I understand and agree that my relationship

with Youchoosecare Ltd is that of an independent,

self-employed contractor and not an employee.

I am solely responsible for my own income tax,

National Insurance, and other statutory

obligations.

I consent to Youchoosecare Ltd conducting verification checks, including verifying my right to work, and DBS

certificate status (if applicable).

I consent to Youchoosecare Ltd conducting

verification checks, including verifying my

right to work, and DBS certificate status

(if applicable).

I agree to abide by Youchoosecare's Ltd Code of Conduct, Terms & Conditions, policies on Safeguarding,

Confidentiality, and Health & Safety, as well as all relevant CQC fundamental standards, while providing care

to clients introduced to me through your service.

I agree to abide by Youchoosecare's Ltd

Code of Conduct, Terms & Conditions, policies

on Safeguarding, Confidentiality, and Health

& Safety, as well as all relevant CQC fundamental

standards, while providing care to clients

introduced to me through your service.

I confirm that I have the necessary right to work in the UK and will provide original documents for verification

if requested.

I confirm that I have the necessary right to

work in the UK and will provide original

documents for verification if requested.

I confirm my Public Liability Insurance status as indicated in the question above.

I confirm my Public Liability Insurance status

as indicated in the question above.

I confirm that I will provide and use appropriate PPE when required during care visits.

I confirm my Public Liability Insurance status

as indicated in the question above.

Electronic Signature

By typing my full name in the box below, I certify that I have read, understood, and agreed to all the points in this declaration. This shall serve as my electronic signature.

Full Name

Date Signed