StorkNCradle

Job Application

First name
Last name
Date of birth (dd/mm/yyyy)
Gender
Height in meters
Weight in kgs
Nationality
Email Address:
Home address
Home telephone
Mobile
How many years have you worked as a nanny, maternity nurse?
What is your level of spoken English?	Poor Fair Good Excellent
What is your level of written English?	Poor Fair Good Excellent
Do you have a valid First Aid certificate?	Yes No
Do you have a valid CRB disclosure?	Yes No
PLease discribe what you have done for the past three years and your childcare experience.
Would you consider a family with...	1 Child 2 Children 3 Children 4 Children
Which ages of children will you care for.	0-12 months 12-24 months 2-3 years 3-4 years 4-5 years 5+ years
Would you accept a single parent family? Single	Mother Father
Placement details, are you looking for	Live-in Live-out Either
Postion required	Aupair Aupair plus Mothers help Nanny Maternity nurse Emergency child care
What date do you wish to start yours placement?
How long do you wish to stay for(in months).
Which areas would you consider working in?	London Cambridge Manchester Leeds Luton Buckinghamshire Bedfordshire Oxfordshire Halifax Bradford Newcastle Hertfordshire The Midlands Other Anywhere in the UK.
If you stated other please specify
Which duties are you prepared to carry for the family as well as the children?	Nursery duties Light cleaning Laundry Small amounts of ironing Cooking meals Bathing Supervise homework Potty training Others not listed
If you picked others not listed please specify.
Do you have a drivers licence?	Yes No
Will you drive in the uk?	Yes No
Do you smoke?	Yes No
If you smoke would you be prepared to not smoke in the family home?	Yes No
Do you have illnesses or injuries?	Yes No
If you answered yes please give details.
Do you have any visible tattoos or body piercings?	Yes No
If yes please specify
Do you have any allergies?	Yes No
If you have allergies please, specify.
Would you go to a family with cats and dogs?	Yes No
Are you a vegetarian?	Yes No
would you expect a non-vegetarian family?	Yes No
Have you been to, or are you in the uk?	Yes No
If yes please give details.
Are you able to attend an interview in london?	Yes No
If no please give details