Registration as a client
Name
Address
Home Tel No.
Work Tel No.
Mobile No.
Fax No.
Email Address You must include an email address to complete registration.
Type of staff required
Nanny Housekeeper Mothers Help
Full Time Part Time
Live in Daily
Approx days per week and hours of work
Dates required from?
Is the position sole charge? Yes No
Do you work from home? Yes No
Do you require any babysitting? Yes No
Do you need a car driver? Yes No
Is there a car provided? Yes No
Annual paid holiday?
Net salary (after deductions for Tax and N.I.)
Do you require any light housework? Yes No
If yes, please give details
Mother:
Name Nationality Occupation
Father:
Child 1:
Name Date of birth Age Sex Male Female School Interests
Child 2:
Child 3:
Child 4:
Do you or any of your children have any special needs or disabilities? Yes No
Do they attend any other classes other than at school? Yes No
Do you have any pets? Yes No
Do you have any other staff employed? Yes No
Does any member of your family smoke? Yes No
Does any member of your family have any dietry requirements? Yes No
Description of the person you are looking for
Have you had a nanny before? Yes No
How did you hear of Family Connections?
Have you any friends who are looking for childcare? Yes No
Do you require a police check? Yes No
Temporary positions only
Please state the start date and length of time required
Hours and days needed
What is the reason for needing a temporary nanny?
Accommodation for a live in nanny
Own room Own flat Shared accommodation (with other staff employed)
If own room... Own bathroom Shared bathroom Own sitting room Shared sitting room Television/Video Please write a brief description
If own flat... Please write a description of the accommodation
If shared accommodation... Please write a description of the accommodation
If the nanny is not needed at the weekends, would you Prefer her to go home Be happy if she stays with you
I confirm that the information given is correct.
Name Date
