First name:
Surname:
House/Flat number:
Address line 1:
Address line 2:
Town/City:
County:
Post code:
Home Telephone no.:
Work Telephone no.:
Mobile Telephone no.:
Email address:
First Name:
Nationality:
Profession:
Religion:
Marital Status:
Child 1 name and date of birth:
Child 2 name and date of birth:
Child 3 name and date of birth:
Child 4 name and date of birth:
Child 5 name and date of birth:
Is a new baby expected?
Do any of your children have special needs?
Do you have any dietary requirements?
Number of additional resident adults
Other staff employed
Household pets
Accommodation type:
Farm: Country: Village:
Town: Suburb: City:
Nearest transport link:
Is this also a business premise?
Daily: Live-in: Weekends:
UK: Overseas: Temporary:
Permanent: Full-time: Part-time:
Occasional: Flexi: Some overnight:
Nanny: Mothers Help: Maternity nurse:
Doula: Nanny share: Fathers Help:
Nursery nurse: Special events: Nights:
Governess: Emergency: Sole charge:
Au pair: Maternity nanny: Housekeeper:
Start date:
Hours of work:
Days of work:
Any overtime/babysitting?
Salary (please state)
Driver required?
Car use provided?
Will you consider nanny with own child?
Annual leave offered
Do you require an Ofsted registered nanny?
Please provide details of the duties you require from your employee:
Can you provide an employer's reference?
How did you hear about the Parent & Child Nanny Agency?
I have read the terms and conditions
