Aegis Nannies nanny & housekeeper on-line application

INSTRUCTIONS:

You will need to fill out this application form in one sitting.
Ignore any sections/questions which do not apply to you.
Please be as thorough as possible in each section.
Please read through the form and collect all the information you need before starting.
To position to the start of the form press the tab key up to 4 times, or position with your mouse.
Use your tab key to move to each new box.
The form should fit entirely within the width of the screen ie. without a horizontal scroll bar. If it doesn't you may need to adjust your screen settings. Firstly make sure the form window is maximised, also some browsers provide e.g. Favourites or History information windows occupying space on the left of the screen and these should be closed. As a last resort you may need to choose a different font/font size eg. Western or Central European(Windows)(11/medium) (use View - Character set/Encoding menu).
When filling in your answers in a text box, DO NOT hit your 'Enter' or 'Return' keys. Continue to type and your text will wrap automatically.
Please click on the 'Submit' button only once.
Please send two passport sized photos and all written references as soon as possible after completing the form.

PERSONAL DETAILS

Full Name:

Email Address:

Address:

Town/City:

County: Postcode:
Telephone:

Mailing Address(if different):

Town/City:

County: Postcode:
Telephone:

Mobile phone:

Works phone number:

Fax number:

National Insurance Nos:

Position required:

Nationality:

Religion:

DOB(dd/mm/yyyy):

Marital status
Married Single Living with partner Widowed

PLACEMENT PREFERENCES

Type of accomodation
Live in Live out

Type of responsibility
Sole charge Shared responsibility

Require permanent post:
Start date(dd/mm/yyyy):

Require temporary post(dd/mm/yyyy):
From: To:

Full-time or Part-time?
F/T P/T

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Times:

Please indicate those family situations in which you would be willing to work (check all that apply):

Newborn
(0-6mths)

Infant
(7mths-1yr)

Toddler
(1-2˝)

Preschool
(2˝-5yrs)

Schoolage
(5yrs+)

Any of
these

Maximum number of children in your care:

Preferred location(eg, London, South of England):

Do you want to be placed on our local baby sitting register?(If yes give details of preferred days):

Join our local baby
sitting register?
Yes No

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Times:

If you have any further information which might help us find you a suitable placement please give details below

Period of Notice in present job(eg.none, 1 month,):

Required Net Salary(Ł):

FAMILY INFORMATION

Mothers Full Name:

Address:

Town/City:

County: Postcode:
Telephone:
Occupation:

Fathers Full Name:

Address:

Town/City:

County: Postcode:
Telephone:
Occupation:

My Brothers:

My Sisters:

EDUCATION

Starting date
(dd/mm/yyyy)

Leaving date
(dd/mm/yyyy)

School and Location

Examinations Passed

Secondary
School

College

University

EXPERIENCE

Starting date
(dd/mm/yyyy)

Leaving date
(dd/mm/yyyy)

Name, address,
Tel no of Employer

Job titles & duties

Number & age
of children at
job start

Job
1

Job
2

Job
3

Job
4

Job
5

(If you are not working at present please give details below)

DRIVING EXPERIENCE

Do you drive?
Yes No

Do you own a car?
Yes No

(Have you ever had an accident or received any convictions(UK and abroad)?)
(If yes give details below):

HEALTH DETAILS

Do you smoke?
Yes No

Are you normally healthy?
Yes No

Number of sick days in the last year:

In the last five years have you suffered from any of the following?:

Hospitalisation:

Recurring medical problems(if yes give details):

Are you receiving any medication?(if yes give details) :

Have you ever received psychiatric treatment?(if yes give details):

Do you suffer from any allergies?(if yes give details):

Are you asthmatic?(if yes what if any medication do you take):

APPLICANTS FOR NANNYSHARE ONLY:
please note that we will be contacting your current employer for further details

Current employers name:

Street: Town/City:
County: Postcode: Telephone:

Present number of children in your care: Number of children willing to care for:

Times currently working?:

Monday

Tuesday

Wednesday

Thursday

Friday

AM
PM

Times available to work?:

Monday

Tuesday

Wednesday

Thursday

Friday

AM
PM

DECLARATIONS:

Have you ever had an accident whilst caring for a child(if yes give details below):

Had an accident while caring for a child?
Yes
No

Has a child ever had an accident whilst in your care(if yes give full details below):

Child had accident in my care?
Yes
No

Do you have a police record? (if yes give details below) :

I have a police record?
Yes
No

Have you had a police check?:

I have had a police check?
Yes
No

It is the policy of Aegis Nannies to check all references. If you have ever been refused a reference or have terminated employment on bad terms please give details as it is easier to prepare a client in advance.

FINAL DECLARATION:

I certify that the information set out herein is true and correct. I authorize Aegis Nannies Limited to use this information, without prejudice, at its sole discretion. I further authorize Aegis Nannies Limited to verify any references which I have supplied. I will treat all information given to me regarding vacant positions as confidential and will not pass on any names and addresses of potential employers to any person or of potential employees to any person. If I obtain a position through Aegis Nannies Limited, I will notify the Company at once and will notify the employer concerned that the agency fee will apply.

Name/Signature

Date

Please note that clicking on the 'Submit' button is your confirmation that all of the information you are submitting is true to the best of your knowledge.

Please click on the 'Submit' button only once.

Thank you for completing the Aegis Nannies Application.

Aegis Nannies, Ltd.
Aegis Nannies, Ltd., 12 Treen Avenue, Barnes, London, SW13 0JT
Tel - 0208 3921658 Fax - 0208 3922386(London)
Monday to Friday: 7:30am - 8:00pm
Sarah@aegisnannies.co.uk
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