Do you have all your documents*
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Yes No
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Personal Details |
Surname*
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First Name*
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Address*
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County*
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Post Code*
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Home Telephone Number
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Mobile Number*
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Email Address*
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Date of Birth*
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Age*
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Place of Birth*
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Nationality*
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Gender*
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Male Female
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Emergency Contact Name*
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Relationship to You*
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Emergency Contact Number*
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Passport / ID Number*
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Passport / ID Date of Issue*
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Passport Date of Expiry* : Please mention Not Applicable if you do not hold a passport
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Is Visa / Work permit Necessary*
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Do you give permission for Norma Lewis Nannies to carry out a “right to work check? (If applicable)
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Yes No
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What is your NI Number* Please write I Do Not Have One , if that is the case
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Position Required
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Are you looking for a position that is*
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LIve In Live Out Either
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Do You wish to be*
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A Nanny A Mother's Help Either
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Minimum salary accepted per week or per hour (NET)*
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Availability
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Available to Start From*
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Minimum length of job required*
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Maximum length of job required*
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Your Family and Yourself
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Marital Status*
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Single Married Divorced Widowed
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Do You Have Children *
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Yes No
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If Yes, what are their ages
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Do you have any brothers and sisters? If so, what are their ages.
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Number and Ages of Nieces/Nephews
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Your Qualifications and Experience
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Previous Work Experience
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Your level of education, and any school, childcare, first aid certificates
or any other certificates that you may hold
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Details of your present occupation
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Enter names, addresses, and tel numbers for minimum 2 referees. (Previous UK employers)*
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Please indicate what type of baby/childcare experience you have:
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With Sibling or other Family members
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Yes No
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As an Au Pair
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Yes No
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Previous Nanny positions
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Yes No
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For Mother's Help
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Have you been a Mother's Help before?
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Yes No
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Give brief details about what this job involved
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For Nannies
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Have you been a Nanny before? For how long?
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Give details about what this job involved
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For Both Nannies and Mother's Helps
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Can you:
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Prepare Formula Milk
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Yes No
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Feed a baby
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Yes No
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Change a nappy
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Yes No
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Wean a baby
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Yes No
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Prepare a simple meal for children using fresh ingredients
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Yes No
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Do Arts and Crafts
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Yes No
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Read a story in English
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Yes No
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Help with written homework in English
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Yes No
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Drive a child to and collect from school
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Yes No
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Walk a child to and from school
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Yes No
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What would you do
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To entertain a child on a wet day
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To entertain a child on a dry day
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If a child bites or has a tantrum
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How would you discipline a child
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What snacks would you give a child
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Health and Safety
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What would you do if a child:
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Chokes
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Falls
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Vomits constantly
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Has a temperature
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What could you see as a danger inside the home
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What could you see as a danger outside the home
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Travel (for both Nannies and Mother's Helps)
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Will you travel with a family if required?
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Yes No
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Do you have any visa / passport restrictions on travel?
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Yes No
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What are these restrictions?
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Do you speak any other languages?
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I am happy to work with children
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Tick any that apply
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I do not mind
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Yes No
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0-1 years
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Yes No
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1-3 years
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Yes No
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3-5 years
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Yes No
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5-10 years
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Yes No
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10+ years
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Yes No
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I am happy to help with a physically disabled child
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Yes No
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I am happy to help with a mentally disabled child
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Yes No
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I am happy to work in a family
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2 adults with children
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Yes No
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Single father
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Yes No
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Single Mother
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Yes No
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With a different religion to my own
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Yes No
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Will you work with a family with pets?
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Yes No
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Are there any animals you really dislike?
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Would you help with pets as part of your job?
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Yes No
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More details about you
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Do you have any allergies? If so, to what, and to what extent?
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Are you under medical treatment for any condition? Please explain*
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Is there any reason that you could not safely fulfill your duties looking after children*
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Yes No
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Are there any foods you never eat?
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Do you smoke* ?
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Yes No
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If yes, how many per day
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Will you promise not to smoke at work or in the presence of the children?
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Yes No
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What hobbies and interests do you have? Can you swim? play sports? love dancing?
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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). *
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Yes No
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Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post?*
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Yes No
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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.
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Do you hold a current enhanced disclosure certificate? (DBS check.)*
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Yes No |
Do you authorise Norma Lewis Nannies to apply for a DBS on your behalf *
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Yes No
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Do you authorise Norma Lewis Nannies to disclose the information on your DBS to future employers?
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Yes No
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Driving
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Do you have a driving license valid for the UK? *
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Yes No
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Are you experienced at driving in the UK ?
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Yes No
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Do you have any points or endorsements?
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Yes No
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If so, how many and for what?
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Do you have your own car? *
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Yes No
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Can you drive
Auto
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Yes No
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Manual
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Yes No
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And Finally
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Do you hold any Nanny Insurance Cover? (Recommended for all Nanny childcare positions)
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Yes No
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Would you like any
information on this?
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Yes No
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Norma Lewis Nannies runs Training courses. Would you like information on the following courses : |
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Ofsted compliant Paediatric First Aid * |
Yes No |
Ofsted Compliant Common Core Skills* |
Yes No |
Ofqual Safeguarding Level 2 or 3 * |
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? *
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Which other agencies have you contacted?*
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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:
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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.
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Name*
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Date*
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