Name

Address

Postcode

Home Telephone

Mobile Telephone

Email Address

Occupation

Nationality

Religion

Marital Status

Partners Name

Partners Occupation

Name of next of Kin

Their contact No.

Do you have children of your own?

Yes

No

If yes, how many and what ages:

Position Required (tick relevant boxes)

Nanny Mothers help Maternity Nurse Daily Live-in

If Live-in - do you require separate accomodation? Yes No

Working Hours (tick relevant boxes)

Permanent Temporary Either

Full-time Part-time Either

If part-time, please indicate preferred days/hours

Nursery duties (children's room(s)/laundry/meals

Yes No

Help with shopping

Yes No

Light housework

Yes No

Full housework

Yes No

School runs

Yes No

What net salary per week are you looking for:

What date are you available to start a new position:

Describe your ideal position (number of children, ages, hours etc)

Employment History

Education and Qualifications

Secondary School:

Dates attended:

Qualifications obtained:

Further Education:

Dates attended:

Your Tutor:

Qualifications obtained:

Further Education:

Dates attended:

Your Tutor:

First Aid

Do you hold a current First Aid Certificate? Yes No

If yes, please provide details delow:

About You

Driving:
Do you hold a driving licence? Yes No
If yes, what date did you pass your test:

Do you have any convictions or fixed penalties? Yes No
If yes, please provide details:

Do you have use of a car? Yes No
If yes, what is the make and model of your car:

Do you require a car as part of the position? Yes No

Smoking:

Do you smoke? Yes No
If yes, would you accept not to smoke whilst on duty? Yes No

Hobbies and Interests:
Please list your hobbies and interests:

General

Can you swim? Yes No

Can you play any musical instruments? Yes No

If yes, which instruments do you play:

Do you speak any foreign languages? Yes No
If yes, what are they:

Health

Do you have any health problems that may affect your work?
Yes No - If yes, please provide details:

Do you suffer from any allergies? Yes No
If yes, what are they:

Are you taking any medication? Yes No
If yes, please provice details:

Have you ever received psychiatric treatment? Yes No
If yes, please provide details:

Criminal Convictions

Do you have any spent or unspent criminal convictions?
Yes No - If yes, please provide details:

Do you hold a CRB check? Yes No
If yes, please provide date obtained:

Personal Profile

Please provide a brief description of yourself, your personality and
your approach to working with children:

Babysitting Register - We are often asked for babysitters.
Please indicate whether you would like your details to be included on
our babysitting register Yes No