SINGLE STAR NANNIES  
DOUBLE STAR NANNIES  
TRIPLE STAR NANNIES  
 (To be determined by Aegis Nannies)
Aegis Nannies, Ltd.
Tel - 0044 (0)208 3921658
Fax - 0044 (0)208 3922386
email -
Sarah@aegisnannies.co.uk
Please return this completed application with two Recent Passport Photos of yourself
FOR OFFICE USE ONLY
Date Nanny Interviewed
Hired by: Date:
Hired by: Date:
   (Click Here to Print)






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
Number:
Position required:

 Nationality:

 Religion:

 DOB(dd/mm/yyyy):
Please circle your Marital status:
Married
 Single
 Living with partner
 Widowed
PLACEMENT PREFERENCES
Type of accomodation(please circle): Live in
 Live out
Type of responsibility(please circle): Sole charge
 Shared
Require permanent post:
 Require temporary post:
Start date(dd/mm/yyyy):
 Date from (dd/mm/yyyy):
Date to (dd/mm/yyyy):
Full-time or Part-time?
(please circle)
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday
 Saturday
 Sunday
F/T
P/T

 Times:

 Times:

 Times:

 Times:

 Times:

 Times:

 Times:
Please indicate the family situations in which you would be willing to work(tick all that apply):
Newborn
(0-6mths)
 Infant
(7mths-1yr)
 Toddler
(1-2½yrs)
 Preschool
(2½-5yrs)
 Schoolage
(5yrs+)
 All
apply
Maximum number of children
you are willing to care for:
 Preferred location(eg London, South East):
Do you want to be placed on our baby sitting register?(If so please circle the preferred days):
Join baby sit register?
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday
 Saturday
 Sunday
Yes
No
 Times:


 Times:


 Times:


 Times:


 Times:


 Times:


 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(£):
FAMILY INFORMATION
Mothers Full Name:
 Fathers Full Name:
Address:

Town/City:

County:

Postcode:

Telephone:

Occupation:

 Address:
(if different)
Town/City:

County:

Postcode:

Telephone:

Occupation:

My Brothers and Sisters (please give details eg. name, age, etc.):
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
(please include all written references)
(most recent first)
  Starting date
(dd/mm/yyyy)		 Leaving date
(dd/mm/yyyy)		 Name, address,
Tel no of
Employer		 Job titles & duties Number & age of children
at start of job
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?(please circle): Yes
 No
Do you own a car?(please circle): Yes
 No
(Have you ever had an accident or received any convictions(UK and abroad)?)
(If yes please give details below):
HEALTH DETAILS
Do you smoke?
(please circle correct answer)
 Yes
No
 Are you normally healthy?
(please circle correct answer)
 Yes
No		 Number of sick days in the last year:
In the last five years have you suffered from any of the following?:
Hospitalisation(if yes please give details):
Recurring medical problems(if yes please give details):
Are you receiving any medication?(if yes please give details) :
Have you ever received psychiatric treatment?(if yes please give details):
Do you suffer from any allergies?(if yes please 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?(please circle correct answer):
Monday
 Tuesday
 Wednesday
 Thursday
 Friday
AM
PM
 AM
PM
 AM
PM
 AM
PM
 AM
PM
Times available to work?(please circle correct answer):
Monday
 Tuesday
 Wednesday
 Thursday
 Friday
AM
PM
 AM
PM
 AM
PM
 AM
PM
 AM
PM

DECLARATIONS FOR ALL APPLICANTS:
Have you ever had an accident whilst caring for a child(if yes please give details below):
Had an accident while caring for a child?
(please circle correct answer)

Yes

No




Has a child ever had an accident whilst in your care(if yes please give full details below):
Child had accident in my care?
(please circle correct answer)

Yes

No




Do you have a police record? (if yes please give details below) :
I have a police record?
(please circle correct answer)

Yes

No




Have you had a police check? (if yes please give details below) :
I have had a police check?
(please circle correct answer):		 Yes
 No
It is Aegis Nannies' policy to check all references. If you have ever been refused a reference or have terminated employment on bad terms give details below as it is easier to prepare a client in advance.




FINAL DECLARATION FOR ALL APPLICANTS:
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:

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
©2000-2004, Aegis Nannies Applications - All rights reserved