Nanny Registration Form
* indicates required fields 
  *Title:
  *Full Name:
  *Address:
  *Post Code:
  Email Address:
  *Home Telephone Number:
  Mobile Telephone Number:
  *Date of Birth:
  *Marital Status:
  *Do You Have Your Own Form of Transport:
  *Is Your Car Insured For Business Use:
  *Do You Smoke:
  *Would You Work In a Household That Had Pets:
  *Do You Have Any Allergies:
  If So What Are They:
  *Type of Employment Wanted:  Full Time
 Part Time
 Temporary
 Permanent
  *Type of Position Wanted:  Nanny
 Nursery Nurse
 Mothers Help
  *Distance You Are Prepared To Travel To Work:
  *Happy in a Placement Where Parents Work From Home:
  *Would You do Temp Work Until Permanent Available:
  *Minimum Hourly Rate (£ per hr):
  *Date Available to Start:
  *Childcare Qualifications Held (e.g. NVQ Level 3):
  *Other Training Courses (e.g. First Aid etc):
  *Any Hobbies/Interests:
  *Do You Hold an Enhanced Disclosure:
  *Employment Details (Starting With Most Recent):
  *How Many Sick Days in Last 12 Months:
  *Ages of Children You'd Like to Work With:
  *Max Number of Children You'd Work With:
  *Days Available To Work:
  *Reference 1 (Name,Address,Tel & Relationship):
  *Reference 2 (Name,Address,Tel & Relationship):
  *Reference 3 (Name,Address,Tel & Relationship):
  *How Did You Hear About Rock-a-bye Nanny Agency:
  *Are You Interested in Our Baby Sitting Service:
  If Yes - How Much Do You Charge (£ per hr):
  *I Certify That The Information Provided is Correct:  I Agree
 

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