Booking A Nanny
About You
Full Name:
Address Line 1:
Address Line 2:
Town/City:
County:
Post Code:
Day Time Telephone:
Evening Telephone:
e-mail address:
Occupation:
Do you work from home:
Yes
No
Nationality:
The Working Environment
Do you have any pets:
Yes
No
If yes, please give details:
Will you be providing separate sleeping quarters for your nanny?
Yes
No
Will you be able to offer a light:
breakfast
lunch
dinner
Do any of your children have any special dietary requirements?
Yes
No
If yes, please give details
Are you or anyone in your household a smoker?
Yes
No
Please give details of the children that will be in our care:
Name
Age
Gender
Other relevant
details
M
F
M
F
M
F
M
F
About the Position
What type of childcare do you require:
Nanny
Mothers Help
Maternity Nurse
Please state which days of the week would you want your nanny to work
Please state which nights of the week would you want your nanny to work
Do you requrie a nanny who is able to drive?
Yes
No
Will you be providing a nanny car?
Yes
No
Do you require your nanny to be a non-smoker?
Yes
No
Are you willing to pay mileage allowance?
Yes
No
When do you require a nanny to start?
Please give a brief outline of the duties to be fulfilled by your nanny:
And finally, where did you hear about us?
Declaration:
I confirm that I have read and agree to the terms of business and that the information submitted on this form is true and correct to the best of my knowledge
Yes, I confirm
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