Application Form for a Nanny / Mother’s Help

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IMPORTANT INFORMATION!
Before you complete this Form:

All applicants must be in the UK
You must have spoken to Norma Lewis on 07956 89 45 89
You will need to have your papers ready
- Proof of ID ( Passport or ID card)
- Copy of Permit if required.
- 2 References in writing (These cannot be from Friends or Family Members)
- Any relevant Certificates (Both Childcare and First Aid.)
- Driving Licence (If applicable.)
- CV, giving full details of your Work History and duties. (Include any experience with Children of Friends and Family). Please explain any gaps in employment.
- Some Photos of yourself - happy, smiley ones, because no Family will want a miserable Nanny!
- DBS Disclosure / Police Check Certificate. A Disclosure will be requested in the event of an individual being offered a position.

Email the information to norma@normalewisnannies.co.uk
If you have any problems with any of these papers, please let me know, so that I can try to help you.

Do you have all your documents*	Yes No
Personal Details
Surname*
First Name*
Address*
County*
Post Code*
Home Telephone Number
Mobile Number*
Email Address*
Date of Birth*
Age*
Place of Birth*
Nationality*
Gender*	Male Female
Emergency Contact Name*
Relationship to You*
Emergency Contact Number*
Passport / ID Number*
Passport / ID Date of Issue*
Passport Date of Expiry* : Please mention Not Applicable if you do not hold a passport
Is Visa / Work permit Necessary*
Do you give permission for Norma Lewis Nannies to carry out a “right to work check? (If applicable)	Yes No
What is your NI Number* Please write I Do Not Have One , if that is the case
Position Required
Are you looking for a position that is*	LIve In Live Out Either
Do You wish to be*	A Nanny A Mother's Help Either
Minimum salary accepted per week or per hour (NET)*
Availability
Available to Start From*
Minimum length of job required*
Maximum length of job required*
Your Family and Yourself
Marital Status*	Single Married Divorced Widowed
Do You Have Children *	Yes No
If Yes, what are their ages
Do you have any brothers and sisters? If so, what are their ages.
Number and Ages of Nieces/Nephews
Your Qualifications and Experience
Previous Work Experience
Your level of education, and any school, childcare, first aid certificates or any other certificates that you may hold
Details of your present occupation
Enter names, addresses, and tel numbers for minimum 2 referees. (Previous UK employers)*
Please indicate what type of baby/childcare experience you have:
With Sibling or other Family members	Yes No
As an Au Pair	Yes No
Previous Nanny positions	Yes No
For Mother's Help
Have you been a Mother's Help before?	Yes No
Give brief details about what this job involved
For Nannies
Have you been a Nanny before? For how long?
Give details about what this job involved
For Both Nannies and Mother's Helps
Can you:
Prepare Formula Milk	Yes No
Feed a baby	Yes No
Change a nappy	Yes No
Wean a baby	Yes No
Prepare a simple meal for children using fresh ingredients	Yes No
Do Arts and Crafts	Yes No
Read a story in English	Yes No
Help with written homework in English	Yes No
Drive a child to and collect from school	Yes No
Walk a child to and from school	Yes No
What would you do
To entertain a child on a wet day
To entertain a child on a dry day
If a child bites or has a tantrum
How would you discipline a child
What snacks would you give a child
Health and Safety
What would you do if a child:
Chokes
Falls
Vomits constantly
Has a temperature
What could you see as a danger inside the home
What could you see as a danger outside the home
Travel (for both Nannies and Mother's Helps)
Will you travel with a family if required?	Yes No
Do you have any visa / passport restrictions on travel?	Yes No
What are these restrictions?
Do you speak any other languages?
I am happy to work with children
Tick any that apply
I do not mind	Yes No
0-1 years	Yes No
1-3 years	Yes No
3-5 years	Yes No
5-10 years	Yes No
10+ years	Yes No
I am happy to help with a physically disabled child	Yes No
I am happy to help with a mentally disabled child	Yes No
I am happy to work in a family
2 adults with children	Yes No
Single father	Yes No
Single Mother	Yes No
With a different religion to my own	Yes No
Will you work with a family with pets?	Yes No
Are there any animals you really dislike?
Would you help with pets as part of your job?	Yes No
More details about you
Do you have any allergies? If so, to what, and to what extent?
Are you under medical treatment for any condition? Please explain*
Is there any reason that you could not safely fulfill your duties looking after children*	Yes No
Are there any foods you never eat?
Do you smoke* ?	Yes No
If yes, how many per day
Will you promise not to smoke at work or in the presence of the children?	Yes No
What hobbies and interests do you have? Can you swim? play sports? love dancing?
Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? (Note the post you have applied for is exempted under the Rehabilitation of Offenders Act 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need be disclosed). *	Yes No
Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post?*	Yes No
If you have answered “yes” to either of the above questions, please send details of offences, penalties and dates, in confidence, to Norma Lewis, at norma@normalewisnannies.co.uk This information will only be seen by those who need to see it as part of the recruitment process.
Do you hold a current enhanced disclosure certificate? (DBS check.)*	Yes No
Do you authorise Norma Lewis Nannies to apply for a DBS on your behalf *	Yes No
Do you authorise Norma Lewis Nannies to disclose the information on your DBS to future employers?	Yes No
Driving
Do you have a driving license valid for the UK? *	Yes No
Are you experienced at driving in the UK ?	Yes No
Do you have any points or endorsements?	Yes No
If so, how many and for what?
Do you have your own car? *	Yes No
Can you drive Auto	Yes No
Manual	Yes No
And Finally
Do you hold any Nanny Insurance Cover? (Recommended for all Nanny childcare positions)	Yes No
Would you like any information on this?	Yes No
Norma Lewis Nannies runs Training courses. Would you like information on the following courses :
Ofsted compliant Paediatric First Aid *	Yes No
Ofsted Compliant Common Core Skills*	Yes No
Food & Hygiene/ Nutrition (0-5 years) *	Yes No
Are you Ofsted Registered*	Yes No
If you would like to be Ofsted registered, would you like to receive information on Norma Lewis Nannies’ Ofsted Registration Service?*	Yes No
How did you hear of this agency? *
Which other agencies have you contacted?*
APPLICANT DECLARATION Submitting this form in any format to the Norma Lewis Nannies shows that you have read, understood, and accepted the following Terms, and will agree to be bound by them:
TERMS I declare that I am medically fit, and have no condition that would mean I could not safely be left to discharge my duties, and be responsible for any children and / or babies in my care. I declare that to the best of my knowledge, all the above information within my application is correct and true. Should any information change, I will notify Norma Lewis Nannies immediately. I authorise Norma Lewis Nannies to disclose to potential employers those of my confidential details (both personal and professional ) that are necessary to help find me work. Once I have been offered a position, and after I have accepted, I will notify the agency immediately. I will not start my new position until after I have received my confirmation of employment details from Norma Lewis. I will not privately approach any employer introduced to me by Norma Lewis for work. I will pay for any private telephone bills incurred during my placement. If for any reason I wish to terminate my contract of employment before the completion of my first 10 weeks’ employment, I will inform Norma Lewis (telephone 07956 89 45 89) prior to notifying my employer. Furthermore, I must complete the correct Notice period as agreed with my Employer, subject to certain exceptions to be discussed with Norma Lewis. Failure to comply with the above means that I will automatically be deemed to be "In breach of contract" with both the Agency, and the employer. In such an event, I will be subject to a penalty equivalent to one week's salary, payable to the Agency. I understand that I can be given notice, or summarily dismissed if: a) I fail to abide by this agreement b) I have given false information on my application form c) I break the law, or act in a way that endangers any children in my care.
Name*
Date*