Buttons Nanny Agency Nanny Registration  Form

For Buttons Sutton Please fax back to 020 8395 0006 For Buttons London Please fax back to 020 8997 3317
Or mail to:
Buttons Nanny Agency, 189 Benhill Rd, Sutton, Surrey
SM1 3SB		 Or mail to:
Buttons Nanny Agency, 25 Greystoke Park Terrace, Ealing, London W5 1JL

 

Click here to print this page

 

Last Name
First Name
Title
Maiden Name (if applicable)
Address
Street
Town
County
Postcode
Mobile Tel.
Home Tel.
Work Tel.
Fax No.
Email Address
Age
Date of Birth (dd/mm/yy)
Nationality
Marital Status Single Married  Divorced
Do you have children? Yes No
If yes what are the ages
Childcare Qualifications

NNEB DNN BTECH
NVQ2 NVQ3
Other
Not Qualified

No. of years experienced as a full time employed nanny?
No. of years employed full time in other childcare fields (i.e. Nursery, School etc)
Do you have a criminal record? Yes No
Do you have a recent Criminal Records Bureau Disclosure Yes No
If yes please supply:  
the date of issue
Name of Registered Body
 
If a CRB check is in the process of being carried out please supply:  
date applied for
Name of the registered body processing
Driver (It is essential to drive for vacancies with Buttons Surrey) Yes No
How long have you held a full driving licence?
Any driving convictions Yes No
Car Owner Yes No
Are you willing to use your car at work (mileage paid) Yes No
Type of post seeking

Daily Nanny
Nursery Nurse
Permanent
Temporary
If Part Time Specify no of days available and any particular days of the week you are available
Are you a smoker (please be honest as some clients are strongly against smokers Yes No
No of days sick and unable to attend work in the past 12 months
Are you a swimmer Yes No
Hobbies and interests
Do you have a first aid certificate Yes No
If yes please give details
Cooking Skills Excellant Average Basic
Available From
Notice Period
Temp (specify dates available from & duration)
Preferred areas to work in
Minimum Pay Required
How did you hear about the Agency
 

Childcare Course Details

Please give Name and Address of college attended for childcare courses, dates attended, course tutors and course taken 
 

Employment Records (most recent first). Please list all employment, childcare or otherwise.
If you have any gaps between employment, please explain.
Newly qualifying candidates please list names, addresses and telephone numbers of referees below.  

 

Reference 1

Employers name and address
Home Telephone
Work Telephone
Ages of children on commencement
Salary (please state nett or gross)
Period of employment from (mm) (yy)
to (mm) (yy)
or still employed
Position held
Sole charge Yes No
Reasons for leaving
Can we contact for reference Yes No
 

Reference 2

Employers name and address
Home Telephone
Work Telephone
Ages of children on commencement
Salary (please state nett or gross)
Period of employment from (mm) (yy)
to (mm) (yy)
or still employed
Position held
Sole charge Yes No
Reasons for leaving
Can we contact for reference Yes No
 

Reference 3

Employers name and address
Home Telephone
Work Telephone
Ages of children on commencement
Salary (please state nett or gross)
Period of employment from (mm) (yy)
to (mm) (yy)
or still employed
Position held
Sole charge Yes No
Reasons for leaving
Can we contact for reference Yes No
 

Reference 4

Employers name and address
Home Telephone
Work Telephone
Ages of children on commencement
Salary (please state nett or gross)
Period of employment from (mm) (yy)
to (mm) (yy)
or still employed
Position held
Sole charge Yes No
Reasons for leaving
Can we contact for reference Yes No
 

Reference 5

Employers name and address
Home Telephone
Work Telephone
Ages of children on commencement
Salary (please state nett or gross)
Period of employment from (mm) (yy)
to (mm) (yy)
or still employed
Position held
Sole charge Yes No
Reasons for leaving
Can we contact for reference Yes No
Additional Information
I confirm that all of the above information is true and accurate. I also confirm that I do not have any criminal convictions

 

Signed    Date

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