Job Registration Form - Koala Nannies Agency In London

Please fill out the fields below. When you are finished you may press
the Send button to submit it to us or if you make a mistake you can press Clear Form.

Date:
Name:
Age: Date of Birth:
Address:
Email Address:
Telephone: Mobile:
Nationality: Religion:
Where would you prefer to work?
Would you like to: Live-In Live-Out Full-Time Part-Time
Dates Available: From: To:
Are you a driver?
Test pass date:
Position Required: Nanny Maternity Nurse Mothers Help Cook
Housekeeper Carer Other
Salary Expectation:(£ per week) Sole Charge Semi-Sole Charge

Training & Qualifications:
What is your swimming ability? Do you have a First Aid Certificate?
Experience/Work History:

Life/Career Goals:

How would you describe yourself:

Hobbies & Interests - Including Languages, Special Talents etc:

Family Details:
Are your parents? Married Divorced Deceased
What are your parents occupations?
Do you have any Brothers or Sisters? Do you have any Nephews or Nieces?

Please supply a health certificate from your doctor, and details of;
Recent Illnesses - Operations - Allergies - Medication - Addictions - Etc
Are you a: Non Smoker Social Smoker
Do you like animals? Can you ride a Horse?
Domestic:
Will you do housework: Ironing Nursery Duties Only
Are you a: Vegetarian Vegan Will you cook meat?
Please outline your travel plans in brief
Are you travelling alone? Do you have a partner - spouse?
Do you have any children of your own? If so, how many?
PLEASE SUPPLY A SMALL PHOTOGRAPH OF YOURSELF BY EMAIL
Two references, at least one regarding childcare is required.

Include Name, Address Telephone, Fax and Email

Next of kin:

DECLARATION:

I confirm that the information I have given is correct & true

I agree not to accept bookings with anybody introduced to me
by Koala Nannies Agency on a private basis or other.

I agree to refer my employer (The Client) back to Koala Nannies Agency
if extra work is required of me or contact of (The Client) requires my services.

How did you hear about Koala Nannies?
Have you registered with any other employment agencies?
Please Note: An Interview is required, before any candidate is placed for a position

Child Care: Experience and preference (tick appropriate boxes)
	Experienced With	Prefer to work with
0-6 Months
6 Months - 1 Year
1-2 Years
2-5 Years
5-10 Years
Elderly
Special Needs