Buttons Nanny Agency Surrey and West London clients application form

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Clients Application

Please check that you reside within (or near to) our areas:

Surrey & Wimbledon SW18 & SW19 Branch
West London & Harrow Branch

Please fill in our Employers Form

If you would like to print this form and either fax or mail it to us click here

Title
If other please state
First Name
Last Name
Address
Street
Town
County
Postcode
Mobile: (enter as 12345 123456)
Tel. Home (inc STD code)
Tel. Work (inc STD code)
Fax No.
Email Address * required field
Type of Daily Nanny Required	Full Time Daily Part Time Permanent Temporary Sole Charge Not Sole Charge Driver Essential Driver Not Important
Nursery Duties	Yes No
Would you consider a qualified nanny accompianied by their own child?	Yes No Possibly This arrangement is not suitable for all options & depends on the ages and number of children in the nanny’s care
Are there any dietary requirements?
Duration of booking if temp
If part time, please specify the number of days required	Number of days required
If part time, please specify any particular days of the week that are essential
Are there any home workers or adults in the house during the daytime? * required field	Yes No
If yes, please provide details
Nanny car provided for use at work * required field	Yes No
Nanny car to take home * required field	Yes No
Car owner essential (mileage paid) * required field	Yes No
Number of children * required field
Names and Ages of children at commencement (please indicate M male or F female)
Schools and nursery attended by the children
Childrens hobbies, interests and activities
Is there a new baby expected	Yes No
Are you currently on Maternity Leave?	Yes No
Date Nanny required from
Could you wait for the right candidate to give 1 months notice	Yes No
Hours of work required - please include start and finish times
Rates of pay £	Minimum Maximum Per Month Per Week Nett Gross
Would you like the services of our payroll company - Domesticpaye? (This incurs an extra cost)	Yes No Not sure
No. of weeks paid holidays (min 4 weeks & Bank Hols pro rata) please give details
Have you had a nanny before * required field	Yes No
Is other help kept	Yes No
If yes please give details
Duties required ? These can vary depending on number of days/hours worked (If you are unsure at this stage please leave this blank ? the agency can discuss with you) please tick as appropriate	Childcare only Cleaning & tidying of the playroom Taking & collecting children from school & nursery Preparing childrens meals Helping with homework and reading Taking children to suitable age appropriate activities, clubs, outings , social visits with friends and having childrens’ friends home to play Changing & washing childrens’ bed linen Washing childrens’ clothes Ironing childrens’ clothes Cleaning of childrens’ bedrooms
Duties required - additional information
Clients Occupation	Male Female
Do you have any pets?	Yes No
If so please give details.
Nationality
Religion
How did you hear about Buttons? * required field
Where did you get our telephone number/details from? * required field
Have you been registered with Buttons previously?	Yes No Not sure
If you heard of the agency via the internet please give details of website name or search engine name
Keywords entered for search engine
Additional Information
I have read and agree with Buttons Nanny Agency's Terms of Business * required field

Submit this form to Please submit Wimbledon SW19/20 to Surrey Branch

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