CQC Registration Details

Thank you for choosing Agency Care staff Ltd to support you with the CQC Registration.

In order to speed up the process, please provide us with the details below. 

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Directors details

If there is only one director, please leave the other fields empty.
Name of Director 1
Date of Birth director 1
Roles and responsibilities - director 1
Name of Director 2
Date of Birth director 2
Roles and responsibilities - director 2
Name of Director 3
Date of Birth director 3
Roles and responsibilities - director 3
Name of Director 4
Date of Birth director 4
Roles and responsibilities - director 4

Details about the Registered Manager

Name of the Registered Manager
Registered Manager Date of Birth
Registered Manager DBS date of issue

Full employment history for the Registered Manager

Provide details of your full employment history, since you were 16. No gaps greater than 4 weeks between the jobs please.
Start Date Job 1
End Date Job 1
Start Date Job 2
End Date Job 2
Start Date Job 3
End Date Job 3
Start Date Job 4
End Date Job 4
Start Date Job 5
End Date Job 5
Start Date Job 6
End Date Job 6

Details about the Nominated Individual

Name of the Nominated Individual
Nominated Individual's date of birth
Nominated Individual DBS date of issue

Name of the business

Business Address exactly as shown on the Companies House

Business Contact Details

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CQC Registration Details Form

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