Register as a Nanny
Full name
Nationality
Ref No (office use only)
Date
Post required
Please Select
Nanny
Mothers Help
Maternity Nurse
Other
If 'other', please give details
Start date
Address including postcode
email address:
Telephone no.
Religion
Age and date of birth
*If under 18 years, have you had any careers guidance?
Father's occupation
Mother's occupation
Ages of Brothers (if any)
Ages of Sisters (if any)
Experience
Please tick age groups
Newborn
3mths - 1yr
1yr - 3yrs
3yrs - 5yrs
5yrs -7yrs+
Skills
Can you do any of the following?
Swim
Cook
Drive
Do you hold a full licence?
Yes
No
Do you own a car?
Yes
No
Make and model
Have you done any first aid?
Yes
No
If yes, what qualifications?
Other skills
Other information
Do you smoke?
Yes
No
Are you prepared not to smoke in the home?
Yes
No
Which languages do you speak?
Do you
suffer from homesickness?
have any criminal convictions?
have a police certificate?
Are you prepared to work anywhere?
Yes
No
If no, where are you prepared to work?
Are you willing to take a position that is
Daily
Residential
Please give details of any special dietary requirements
Will you do light housework?
Yes
No
Will you work in a family where there are pets?
Yes
No
Are you willing to work with a single parent?
Yes
No
What salary do you expect?
What are your hobbies and interests?
Are you physically fit?
Yes
No
Please give details of any medical conditions
Height
Weight
Education
Name of school/college
Start date
End date
Qualifications
Name of school/college
Start date
End date
Qualifications
Employment history
Name and address of employer
Position and age of children
Start date
Finish date
Reason for leaving
Net salary
References
For immediate instructions to families we need two references
My referees will write directly to the agency
Yes
No
Referees - State whether friend, employer, college tutor etc.
Reference 1
Name
Address
Telephone
Reference 2
Name
Address
Telephone
Agreement to Agency Terms
1. All interviews shall be arranged by the Agency and no arrangements may be made between potential employees and the clients unless authorised by the agency.
2. After an introduction, the Agency must be informed of all further developments.
3. Introduction of clients is confidential and must not be passed to any third parties.
4. The Agency does not insure workers against accident, or possible claims against third parties. Persons put forward by the agency are solely responsible for their own acts or omissions.
NB You are not employed by this Agency. You are employed directly by the people for whom you work.
Declaration: I declare that to the best of my knowledge the details given above are true and that I have read and agree to abide by the above conditions and rules of the Agency.
Declaration:
*
Accept
Full name:
*
Date
*
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