By law we cannot start the work you have asked us to do on your behalf before 14 days after the date of the contract have elapsed. This is to protect you under rights of cancellation under the Consumer Contract Regulation 2013. If you wish to waive these cancellation rights to enable us to proceed with the work immediately, please sign and date at the end of the following clause.
“SUBMISSION OF THE FORM SHOWS THAT “WITH REGARD TO THE CONTRACT DATED (today’s date) AND MY CANCELLATION RIGHTS UNDER THE CONSUMER CONTRACTS REGULATION 2013, I HEREBY WAIVE SUCH RIGHTS AS I WISH YOU TO COMMENCE WORK UNDER THE TERMS OF THE CONTRACT WITH IMMEDIATE EFFECT, AND I UNDERSTAND THIS WILL RENDER ME LIABLE FOR ANY PROPER CHARGES MADE UNDER THE TERMS OF THE SAID CONTRACT.
We offer a 10% discount on the permanent placement fee for new clients, and a 15% discount for returning clients, who have previously taken a permanent applicant through either Norma Lewis Domestic Staff, or Norma Lewis Nannies, in return for giving Norma Lewis Nannies Sole Agency. For those families who choose not to give sole agency, there will be a £50 registration fee.
(For full details on Registration and Administration charges please read Agency Terms, Clause 5.)
| Would you like this discount * |
Yes No |
Personal Details |
| Full Name and Title* |
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| Address* |
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| Postcode* |
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| Home Telephone No* |
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| Mobile Phone No* |
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| Work Telephone No |
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| Email* |
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Family Details |
| Mother's & Father's Marital Status |
Single Married Widowed Divorced |
| Father's Age |
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| Father's Nationality |
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| Father's Religion |
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| Father's Occupation |
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| Mother's Age |
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| Mother's Nationality |
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| Mother's Religion |
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| Mother's Occupation |
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| Name, Sex, Age of Children |
| 1 |
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| 2 |
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| 3 |
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| 4 |
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| 5 |
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| New Born Baby Due |
Yes No |
| Do you or your children have any medical conditions, or any other specific special needs |
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Family Hobbies & Interests |
| What are your family's hobbies and interests |
Reading Computer Games Music Walking Cycling Horse Riding Swimming Cinema |
| Which sports do your family enjoy |
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| Any other interests or after school activities |
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| Do you have any pets |
Yes No |
| If so what are they |
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About the Job |
| Is this position |
Live In Live Out Either |
| When do you need a Housekeeper to start |
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| What is the minimum length of contract |
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| What is the maximum length of contract |
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| What will you pay your Housekeeper per week (Net) |
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| Do you accept that you are liable for Statutory Holiday pay for your Employee* |
Yes No |
| Do you accept that you are liable for her tax and N.I contributions* |
Yes No |
| Do you agree to issue a written contract* |
Yes No |
| Will you accept a smoker |
Yes No |
| If Yes are there restrictions |
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Driving |
| Do you need a driver |
Yes No |
| If yes, for what type of journeys |
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| If yes will you provide the car |
Yes No |
| If yes is the car fully taxed and insured, with a current MOT |
Yes No |
| Is the car |
Auto Manual |
| May the Housekeeper have use of the car for themselves |
Yes No |
| NB It is your responsibility to ensure the Housekeeper has the standard of driving you require. |
Duties |
| Do you require your Housekeeper to travel with you |
Yes No |
| If yes, then only Europe or Worldwide |
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| Do you require the Housekeeper to help with the pets as part of his/her duties |
Yes No |
| How |
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| Housework |
Yes No |
| Cleaning |
Yes No |
| Hoovering / Dusting |
Yes No |
| Washing / Ironing |
Yes No |
| Bed Making / Changing |
Yes No |
| Childcare / Playing with Children |
Yes No |
| Sole Charge |
Yes No |
| Feeding babies |
Yes No |
| Taking to / Collecting from school |
Yes No |
| Babysitting |
Yes No |
| Cooking |
Yes No |
| If cooking to what standard, and for how many |
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| Will they be required to work out Family Menus for the week |
Yes No |
| Will they shop for this food |
Yes No |
| Will they make appointments for Trades People |
Yes No |
| Will they supervise this work |
Yes No |
| How many and which hours / days do you wish your Housekeeper to work |
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| Please provide a timetable showing a typical days duties of your Housekeeper |
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Your Home and Area |
| Where is your home |
Village City Suburb City Center |
| Do you own or rent your home * |
Own Rent |
| Is your home |
Detached Semi Detached Terraced Flat |
| How many bedrooms |
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| How many bathrooms |
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| Does it have a garden |
Yes No |
| Computer / internet facilities |
Yes No |
| Is it wireless internet |
Yes No |
| Any other facilities |
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| If a Live-in position, describe your Housekeepers accommodation
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| May the Housekeeper have friends in your home |
Yes No |
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How Long Would it Take to Reach the Following by Walking, Bus or Train/Tube |
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Local shops |
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Bus Stop |
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| Train / Underground |
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Main Shopping Center |
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Library |
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Restaurants Pubs Cafes & Bars |
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Museums |
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Nightclub |
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Which is your nearest train or tube station |
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And Finally |
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Please describe your family and household - e.g. "we are a friendly but hectic household..." |
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| Norma Lewis Nannies runs Training courses. Would you like information on the following courses for you or your Housekeeper/Nanny: |
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Ofsted compliant Paediatric First Aid * |
Yes No |
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Ofsted Compliant Common Core Skills* |
Yes No |
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Food & Hygiene/ Nutrition (0-5 years) * |
Yes No |
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If your Housekeeper is also responsible for Childcare, would you like details on Norma Lewis Nannies’ Ofsted Registration Service?* |
Yes No |
How did you hear about Norma Lewis Nannies * |
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Have you registered with any other agencies, and if so which ones* |
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Family Name* |
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Date* |
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Clients: 020 70 60 40 50 / 020 8950 8611 Applicants: 07956 89 45 89