Nanny Registration Form
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indicates required fields
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Title:
Mrs
Miss
Mr
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Full Name:
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Address:
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Post Code:
Email Address:
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Home Telephone Number:
Mobile Telephone Number:
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Date of Birth:
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Marital Status:
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Do You Have Your Own Form of Transport:
Yes
No
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Is Your Car Insured For Business Use:
Yes
No
N/A
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Do You Smoke:
Yes
No
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Would You Work In a Household That Had Pets:
Yes
No
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Do You Have Any Allergies:
Yes
No
If So What Are They:
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Type of Employment Wanted:
Full Time
Part Time
Temporary
Permanent
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Type of Position Wanted:
Nanny
Nursery Nurse
Mothers Help
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Distance You Are Prepared To Travel To Work:
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Happy in a Placement Where Parents Work From Home:
Yes
No
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Would You do Temp Work Until Permanent Available:
Yes
No
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Minimum Hourly Rate (£ per hr):
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Date Available to Start:
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Childcare Qualifications Held (e.g. NVQ Level 3):
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Other Training Courses (e.g. First Aid etc):
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Any Hobbies/Interests:
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Do You Hold an Enhanced Disclosure:
Yes
No
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Employment Details (Starting With Most Recent):
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How Many Sick Days in Last 12 Months:
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Ages of Children You'd Like to Work With:
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Max Number of Children You'd Work With:
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Days Available To Work:
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Reference 1 (Name,Address,Tel & Relationship):
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Reference 2 (Name,Address,Tel & Relationship):
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Reference 3 (Name,Address,Tel & Relationship):
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How Did You Hear About Rock-a-bye Nanny Agency:
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Are You Interested in Our Baby Sitting Service:
Yes
No
If Yes - How Much Do You Charge (£ per hr):
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I Certify That The Information Provided is Correct:
I Agree
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