Request a Nanny
Family name
Father's name
Mother's name
Full address, including post code:
Telephone
Mobile:
E-mail
Father
Father's profession
Place of work
Telephone no.
Nationality
Mother
Mother's profession
Place of work
Telephone no.
Nationality
Children
Name(s) and age(s) of children
Schools attended
Childrens' hobbies/interests
Family hobbies/interests
Is a baby due?
Yes
No
Will your employee be left in sole charge?
Yes
No
Family religion
Household
Brief description of home
Is it in the town or country?
Town
Country
Do you employ domestic help?
Yes
No
Do you have any pets?
Yes
No
Nearest rail/bus station
Requirements
Any children need special care?
Yes
No
If yes, please give details
Type of staff required
Please Select
Nanny
Mother's help
Domestic staff
Commencement date
Expected hours
How much time off is envisaged?
What net salary do you envisage paying?
Do you require a driver?
Yes
No
Will a car be provided?
Yes
No
Please give a start and finish date for temporary position
Start date
Finish date
Will the employee travel with you on holiday?
Yes
No
Will you accept a smoker?
Yes
No
How many evenings baby-sitting will you require?
Is the position daily or residential?
Daily
Residential
Own room
Yes
No
TV/video
Yes
No
If residential, what accommodation is provided?
Bathroom
Bedroom
Self-contained flat
A letter from you and a photograph of your family will make the position more attractive.
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How did you hear about us?
Please give the name and address of a person who can provide a family reference
Please give a brief description of duties involved to help us to find a suitable person for you.
Agreement to Agency Terms
This is to confirm that I accept and agree to Nanny Connections' terms and conditions of business and fee schedule. I agree to inform the agency by telephone when I have engaged an employee and to send confirmation in writing within 3 days of such telephone call.
I accept:
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Accept
Full name:
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Date:
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