Online Registration Form

Date:
About Yourself:
Title:
Full Name:
Address:
Post Code:
Email Address:
Work Tel No:
Home Tel No:
Mobile phone No:
Best Daytime Number to use:
Present/previous nannies if any. Dates of work and reason for leaving
Present nanny (if any) Previous nanny (if any)
From (dd/mm/yyyy):
From (dd/mm/yyyy):
To (dd/mm/yyyy):
if working notice
To (dd/mm/yyyy):

Name:

Name:
Address & Telephone Number:
Address & Telephone Number:
Reason for leaving:
Reason for leaving:

Your present and previous nannies may be contacted for references.

Employer's Details
Wife Husband
Occupation:
Occupation:
Nationality:
Nationality:
Religion:
Religion:
Please list all pets:
Children
Name:
D.O.B:
Name:
D.O.B:
Name:
D.O.B:
Name:
D.O.B:
Any allergies or Dietary Conditions?
No Yes
If YES Please specify:
Illnesses, disabilities or special needs?
No Yes

If yes please specify:
Employee's Household Responsibilities Required
Children's washing:
No Yes
Children's ironing:
No Yes
Bathroom:
No Yes
Children's rooms':
No Yes
Children's meals:
No Yes
Kitchen:
No Yes
Play areas:
No Yes
Shopping for children:
No Yes
Outside play area:
No Yes
Live in nannies to keep their own rooms tidy:
No Yes
Please add any other household or domestic requirements:
Type of Childcare Required
Position required:
Qualifications required:
Age band:
Experience:
Nett Salary:
Gross salary:
Start Date:
Live in/out:
Live In Live Out
Full Time/Part Time:
Full Time Part Time
If Part-time, working hours required:
Mon
From
To
Tue
From
To
Wed
From
To
Thur
From
To
Fri
From
To
Sat
From
To
Sun
From
To
Babysitting required (maximum of two evenings with increased pay?
No Yes
Would you consider a nanny with their own child/children?
No Yes
Do you need a car driver?
No Yes
Is there use of a car during working hours?
No Yes
How many weeks paid holiday?
Would you consider a smoker?
No Yes
Do you employ anyone else in you household e.g cleaner?
No Yes
If YES please specify:
Please tell us how you heard about Early Birds:
   
DECLARATION

I declare that the above information is, to the best of my knowledge, true and correct at the time of signing and that there have been no relevant omissions.
I declare that I have read and understood the Terms of Business.
I give my consent for information held within this document to be given solely only to prospective candidates for the nanny position I requested Early Birds to fill. No information shall be given to any other third party unless my consent has been requested.
I have read, understand and agree with the Declaration above:
 

It is Early Birds policy that any registering applicant or nanny will not be discriminated against for their age, sex, race or disability. DATA PROTECTION REGISTERED - Registration No PZ9065075 Under the Data Protection Act 1998, we are obliged to inform you that we hold information about your registration on a database and you are entitled to view this data yourself when you request it in writing. (A charge may be required for administration) Please note: We may choose to advertise your vacancy on other reputable job sites and in the local press. No personal information will be disclosed.