Nanny Registration Form:

QUESTIONS FOR CARERS
Name*
Address 1:
Address 2:
Town:
County:
Postcode:
Telephone Numbers
Home * Mobile
E-Mail
Your Requirements
Please Tick
Full Time Nanny
Part Time Nanny
Weekend Nanny/Babysitter
Maternity Nurse/Night Nanny
Nanny/Housekeeper
Parent's Help
Do you require a live in Position?
Yes
Preferred areas of work:
Max Travelling Time:
Do you prefer the town or the countryside?
Town Either
Minimum Salary Required (Gross) :
No. of days per week required:
Give Further Details:
 
 
Personal details
Date of birth
Place of birth
Nationality
Religion
Male/Female?
Are you single?
Yes
No of Children
Driving licence
Yes
Date Test Passed
Any Driving Convictions ?
Yes
If yes, Please give details
Do you own a car ?
Yes
Please Give details of your Interests and Hobbies
Do you smoke ?
Yes
Do you have a criminal record ?
Yes
Date of CRB Check:
Can you swim ?
Yes
Do you have a first aid certificate?
Yes
Give details of any serious illness in the last 3 years
Please give details of any medical conditions or allergies
Are you an approved Nanny ?
Yes
 
Education, Qualifications, Work Experience etc ..
Schools attended (Secondary Schools Onwards)
Name of School:
Address :
Address:
Postcode:
Dates Attended:
Examination Results:
 
Education, Childcare Qualifications
Name of College/University:
Address :
Address:
Postcode:
Dates Attended:
Examination Results:
Please Give Details of your Childcare Experience:

Current/Last Employers
(please note that we shall only contact with your permission)
Contact Name:
Name of Company:
Address:
Address:
Postcode:
Telephone:
Job Title Held:
Duties:
Reason for leaving:
Dates employed (from-to):

Contact Name:
Name of Company:
Address:
Address:
Postcode:
Telephone:
Job Title Held:
Duties:
Reason for leaving:
Dates employed (from-to):

Contact Name:
Name of Company:
Address:
Address:
Postcode:
Telephone:
Job Title Held:
Duties:
Reason for leaving:
Dates employed (from-to):
 
Are you prepared to do the following?
Children's Ironing
Yes
Cleaning Children's Room
Yes
Cooking for Children
Yes
Light Housework
Yes
Families Washing/ironing
Yes
Babysitting
Weekends
Paid
Care for Pets
Yes
Further Details of Your requirements
References
(in all Cases references are Checked)
Contact Name:*
Name of Company:*
Address:*
Address:*
Postcode:
E Mail:
Telephone:*

Contact Name:*
Name of Company:*
Address:*
Address:*
Postcode:
E Mail:
Telephone:*

I certify that the above information is true and correct to the best of my knowledge.

If I become employed directly or indirectly through East Midlands Nannies and Au Pairs or re-employed a further time by a client of East Midlands Nannies and Au Pairs I will advise East Midlands Nannies and Au Pairs immediately

I have no unspent criminal convictions and you have my authority to seek references.

By submitting this form I am certifying agreement with the above.
 
  


Download our Carers Registration Form (PDF)

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