* Title
* First Name* Surname
Home TelWork Tel
Mobile
* Email
* Date of birthNationality
Marital statusSingleMarriedSeperatedDivorcedWidowed
* Address
* Postal codeAge
Religion
Employment SoughtPermanentLive inDailyPart-timeOverseasTemporary
If temporary, for how long?When can you start?
Required Salary £Preferred number of children
Age RangeDo you prefer sole charge?YesNo
CookingYesNo
Light Housework YesNo
Take over in Parent's absenceYesNo
Please Note: . If you choose to print this form, please attach a separate sheet of paper to submit these details.
Primary SchoolSecondary School
Post Secondary Education
Please use the box below to give a complete outline of your education history (include Dates, institutions attended and examinations passed)
Please use the box below to give a complete outline of your employment history (include dates, names and addresses of employers, job titles/descriptions, numbers and ages of children, and reasons for leaving)
Employment 1
Employment 2
Employment 3
Employment 4
Employment 5
Employment 6
Additional InformationYesNo
If so, please provide:
Licence NoYear of test
Have you had any convictions? (driving or other)
Can you swim?YesNo
Do you smoke? YesNoSocial
How many per day?
Do you speak any foreign languages? (Please indicate degree of proficiency)
Have you any dependants? (Please provide details)
Are you in good health?YesNoDate of last medical check
Please give details of any medication being taken and any allergies
Do you have any special dietary requirements?
Do you like animals?
What are your hobbies/interests?
How did you hear about us?
Are you registered with other agencies?YesNo
Other relevant information or requirements
Passport NoDate of issue
Place of issue
Details of current working visas
Have you ever lived abroad?YesNo
If so, please provide details
Father's name and address
Father's occupationWork Tel
Home Tel
Mother's name and address
Mother's occupationWork Tel
Other next of kin - name and address
Relationship to youOccupation
Work TelHome Tel
