Safe & Sound Childcare Agency

Application Form

The following form should only be filled in by nannies. To apply either fill in the following form or
download one here. You can then print and post it to us. Our is address is listed here.

Surname
First Names
Maiden Name
Marital Status

Address

Contact Address

Home Tel.		Work Tel.
Mobile/Pager		E-mail
Date of Birth		Age
Nationality		Religion

Do you have a copy of a recent CRB - enhanced disclosure (please check)?	Yes No	If No, are you happy to get one?	Yes No
Can you drive?	Yes No	Do you have any children?	Yes No
Do you own your own car?	Yes No	Year of test:

Any points/convictions, give details

Do you smoke?	Yes No	Can you swim?	Yes No
Would you smoke at work?	Yes No	Would you travel with a family?	Yes No

Do you like animals?

Yes
No

Do you have any dietary requirements?

Hobbies & Interests:

Health Declaration

Any operations/medical conditions?	Yes No	Details if applicable.
Are you taking any medication?	Yes No	Details if applicable.

Please State your employment history, starting with your first job.

Name, Address and Telephone number of employer	Dates of Employment	Children's age and sex at commencement of position	State days and hours. Live-in or Live-out?	Reason for leaving

Employment details

What type of work do you require? (check as many as applicable)

Nanny
Live-in
Part-time
Babysitting
Maternity Nurse

Mother's Help
Live-Out
Full-Time
Temporary
Permanent

If you are looking for part-time work, please state the hours you are available:

If you are currently working, what is your notice period?		When did you hand in your notice?
What age children would you prefer?		What salary are you looking for?

Qualifications and Schooling

Name of secondary school:
Address:
Dates attended:
Qualifications gained:
Name of College/University:
Address:
Dates attended:
Qualifications gained:
Please state and other qualifications/certificates: (NNEB, GNVQ, NAMCW, First aid, Duke of Edinburgh, Musical, Scouting, etc.)

Job Reference No. (optional)

Please state the names and addresses of two personal referees: