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Registered Nurse Registration

Please fill out this form in full to register with MidCo Care.

IMPORTANT PLEASE READ

- You should allow at least 30 minutes to fill this on-line form in completely.
- There are 10 pages to fill in and fields marked with a red star are mandatory. You will need to complete all mandatory fields to progress to each next page.
- Do not use the back button on your browser. You will find a 'Prev' and 'Next' button at the bottom of each page.
- The final page asks for Proof Documents & Certificates to be uploaded, so please try and have these to hand before you start. NB. You do not have to upload each of these to submit your registration application but you will need to produce the relevant documents before your registration is accepted.
- When the form is complete, you will receive an email to confirm you have submitted the application successfully.

Agency Registration Details

  • RGN
  • RMN
  • RLDN
  • PAYE
  • Limited
  • Single
  • Married
  • Divorced
  • Widowed
Street Address
City
State
Zip Code
Country

Limited Company Only

  • Yes
  • No

Right to Work (Asylum & Immigration Act 1980)

  • Yes
  • No
  • Yes
  • No

Next of Kin / Emergency Contact Details

Street Address
City
State
Zip Code
Country

PETERBOROUGH OFFICE

MidCo Care Head Office
Laxton House
191 Lincoln Road
Peterborough
PE1 2PN

01733 530 580

SURREY OFFICE

MidCo Care
15 Grove Road
Sutton
Surrey
SM1 1BB

0203 829 6297

NORWICH OFFICE

MidCo Care
Sackville Place
44 – 48 Magdalen Street
Norwich
NR3 1JU

01603 340 650

COVENTRY OFFICE

MidCo Care
8 Spencer Road
Coventry
CV5 6PA

02477 714 677

MANCHESTER OFFICE

MidCo Care
279 Moston Lane
Manchester
M40 9WJ

0161 672 6300

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