IMPORTANT INFORMATION!

Before you complete this Form:

1)    All applicants must be in the UK

2)    You must have spoken to Norma Lewis on
        07956 89 45 89

3)    Your will need to have your papers ready

Proof of ID ( Passport or ID card)
Copy of Permit if required.
2 References in writing (These cannot be from Friends or Family Members)
Any relevant Certificates (Both Childcare and First Aid.)
Driving Licence (If applicable.)
CV, giving full details of your Work History and duties. (Include any experience with Children of Friends and Family). Please explain any gaps in employment.
Some Photos of yourself - happy , smiley ones, because no Family will want a miserable Nanny!
CRB Disclosure / Police Check Certificate. A Disclosure will be requested in the event of an individual being offered a position.

Email the information to norma@normalewisdomesticstaff.co.uk

If you have any problems with any of these papers, please let me know, so that I can try to help you.

Do you have all your documents * Yes
No

Personal Details

Surname *

First Names

Address *

Country *

Post / Zip Code *

Home telephone number *

Mobile telephone number

Fax Number

Email address *

Emergency contact name *

Relationship to you *

Emergency contact number *

Date of birth *

Age *

Place of birth *

Nationality *

Gender * Female
Male

Passport / ID Number *

Passport / ID date of issue *

Passport date of expiry (Please enter not applicable if you do not hold a passport) *

Is visa work permit necessary? *

What is your NI number? (Please write “I do not have one” if that is the case.)

Position Required

Are you looking for a position that is * Live In
Live Out
Either

Do you wish to be * A Nanny
Mothers Help
Either

Minimum salary accepted per week or per hour (NET) *

Availability

Available to start from *

Minimum length of job required *

Maximum length of job required *

Your Family and Yourself

Marital Status * Single
Married
Divorced
Widowed

Do you have children? * Yes
No

If so what are their ages

Do you have any brothers and sisters? If so, what are their ages.

Number and Ages of Nieces/Nephews

Your Qualifications and Experience

Previous work experience

Level of spoken English

Your level of education, and any school, childcare, or first aid certificates you may hold

Details of your present occupation

Enter names, addresses, and tel numbers for minimum 2 referees. (Previous UK employers)

Please indicate what type of childcare experience you have:

With siblings or other family members Yes
No

Experience with babies Yes
No

As an Au Pair Yes
No

Previous nanny positions Yes
No

For Mother's Helps

Have you done any housework? Yes
No

How much and what

Are you willing to assist with the following?

Cooking Yes
No

Washing Yes
No

Ironing Yes
No

Housework Yes
No

Have you been a Mothers Help before? For how long

Give brief details about what this job involved

For Nannies

Have you been a Nanny before? For how long?

Give details about what this job involved

Are you willing to assist with the following as part of your job if they were related to the care of the children?

Cooking Yes
No

Washing Yes
No

Ironing Yes
No

For Both Nannies and Mother's Help

(Please ATTACH A CV / JOB HISTORY, AND EXPLAIN IN DETAIL ANY EXPERIENCE YOU HAVE OF CHILDCARE, INCLUDING BABYSITTING, AS WELL AS ANY GENERAL HOUSEWORK YOU MAY HAVE DONE. YOU MUST EXPLAIN ANY GAPS IN YOUR EMPLOYMENT RECORD.)

Can you:

Prepare formula milk Yes
No

Feed a baby Yes
No

Change a nappy Yes
No

Wean a baby Yes
No

Prepare a simple meal for children using fresh ingredients Yes
No

Do arts and crafts Yes
No

Read a story in english Yes
No

Help with written homework in english Yes
No

Drive a child to and collect from school Yes
No

Walk a child to and from school Yes
No

What would you do:

To entertain a child on a wet day

To entertain a child on a dry day

If a child bites or has a tantrum

How would you discipline a child

What snacks would you give a child

Health and Safety

What would you do if a child:

Chokes

Falls

Vomits constantly

Has a temperature

What could you see as a danger insude the home

What could you see as a danger outside the home

Your preferences (for both Nannies and Mother's Helps)

Will you travel with a family if required? Yes
No

Do you have any visa / passport restrictions on travel? Yes
No

What are these restrictions?

Do you speak any other languages?

I am happy to work with children

Tick all that apply

0-1 years Yes
No

1-3 years Yes
No

3-5 years Yes
No

5-10 years Yes
No

10+ years Yes
No

I do not mind Yes
No

I am happy to help with a physically disabled child Yes
No

I am happy to help with a mentally disabled child Yes
No

I am happy to work in a family

2 adults with children Yes
No

Single father Yes
No

Single mother Yes
No

With a different religion to my own Yes
No

Will you work with a family with pets? Yes
No

Are there any animals you really dislike?

Would you help with pets as part of your job? Yes
No

More details about you

Do you have any allergies? If so, to what, and to what extent?

Are you under medical treatment for any condition? Please explain

Is there any reason that you could not safely fulfill your duties looking after children Yes
No

Are you vegetarian? Yes
No

If yes, would you work with a family who was not vegetarian Yes
No

If no, would you work with a family who was? Yes
No

Are there any foods you never eat?

Do you smoke? Yes
No

How many per day?

Will you promise not to smoke at work or in the presence of the children? Yes
No

What hobbies and interests do you have? Can you swim? play sports? love dancing?

Do you have a criminal record Yes
No

Do you hold a current enhanced disclosure certificate? (CRB check.) Yes
No

(This is an exempted position under the Rehabilitation of Offenders Act 1974, and therefore information is required with regards to both spent and current convictions. Please send any relevant information by separate cover, in confidence, to Norma Lewis, at norma@normalewisdomesticstaff.co.uk

This information will only be seen by those who need to see it as part of the recruitment process.)

Driving

Do you have a driving licence valid for the UK? * Yes
No

When did you get your driving licence?

Do you have any points or endorsements? Yes
No

If so, how many and for what?

Do you have your own car? * Yes
No

With rear seat belts? Yes
No

Have you ever driven in the UK? Yes
No

Will you drive in the UK if given practice/lessons by your employers * Yes
No

And Finally

Do you hold any Nanny Insurance Cover? (Recommended for all nanny childcare positions) Yes
No

Would you like any advice on this? Yes
No

How did you hear of this agency? *

What other agencies have you contacted?

Would you like to receive information on Paediatric First Aid courses? Yes
No

APPLICANT DECLARATION
Submitting this form in any format to the Norma Lewis Domestic Staff Agency shows that you have read, understood, and accepted the following Terms, and will abide by them:
(If downloaded, this declaration is to be signed in duplicate, 1 copy for Norma Lewis, and 1 for the applicant)

TERMS

I declare that I am medically fit, and have no condition that would mean I could not safely be left to discharge my duties, and be responsible for any children and / or babies in my care.

I declare that to the best of my knowledge, all the above information within my application is correct and true. Should any information change, I will notify Norma Lewis Domestic Staff immediately.

I authorise Norma Lewis Domestic Staff to disclose my confidential details (both personal and references) to potential employers.

Once I have been offered a position, and after I have accepted, I will notify the agency immediately. I will not start my new position until after I have received my confirmation of employment details from Norma Lewis.

I will not privately approach any employer introduced to me by Norma Lewis for work.

I will pay for any private telephone bills incurred during my placement.

If I am unhappy, and wish to leave my placement I will inform Norma Lewis (telephone 07956 894589), and I will hand in the correct notice as per my contract to my Employer.

I understand that I can be given notice, or summarily dismissed if:
a) I fail to abide by this agreement
b) I have given false information on my application form
c) I break the law, or act in a way that endangers the children in my care.

Name *

Please enter your name to accept our terms and conditions

Date *

Please enter today’s date to accept our terms and conditions

Home

Important Legal Information For Employers

What Is A Nanny / Mother's Help, Housekeeper And Companion Carer

Testmonials

Families / Jobs Available Now

Applicants Available Now

Useful Contacts And Links

Contact Norma Lewis
Domestic Staff

FOR APPLICANTS

How I Can Help Nannies / Mother's Helps

Application Form for a Nanny / Mother's Help

Application Form for a
Housekeeper

Application Form for a Companion Caregiver

FOR FAMILIES

Application Form for a Nanny and Mother's Help

IMPORTANT INFORMATION!

Before you complete this Form:

1)    All applicants must be in the UK

2)    You must have spoken to Norma Lewis on
        07956 89 45 89

3)    Your will need to have your papers ready

Personal Details

Position Required

Availability

Your Family and Yourself

Your Qualifications and Experience

For Mother's Helps

Are you willing to assist with the following?

For Nannies

Are you willing to assist with the following as part of your job if they were related to the care of the children?

For Both Nannies and Mother's Help

Health and Safety

Your preferences (for both Nannies and Mother's Helps)

I am happy to work with children

I am happy to work in a family

More details about you

Driving

And Finally

TERMS

Home Important Legal Information For Employers What Is A Nanny / Mother's Help, Housekeeper And Companion Carer Testmonials Families / Jobs Available Now Applicants Available Now Useful Contacts And Links Contact Norma Lewis Domestic Staff

FOR APPLICANTS

How I Can Help Nannies / Mother's Helps Application Form for a Nanny / Mother's Help Application Form for a Housekeeper Application Form for a Companion Caregiver

FOR FAMILIES

Application Form for a Nanny and Mother's Help

IMPORTANT INFORMATION!

Before you complete this Form: 1) All applicants must be in the UK 2) You must have spoken to Norma Lewis on 07956 89 45 89 3) Your will need to have your papers ready

Personal Details

Position Required

Availability

Your Family and Yourself

Your Qualifications and Experience

For Mother's Helps

Are you willing to assist with the following?

For Nannies

Are you willing to assist with the following as part of your job if they were related to the care of the children?

For Both Nannies and Mother's Help

Health and Safety

Your preferences (for both Nannies and Mother's Helps)

I am happy to work with children

I am happy to work in a family

More details about you

Driving

And Finally

TERMS

Home

Important Legal Information For Employers

What Is A Nanny / Mother's Help, Housekeeper And Companion Carer

Testmonials

Families / Jobs Available Now

Applicants Available Now

Useful Contacts And Links

Contact Norma Lewis
Domestic Staff

How I Can Help Nannies / Mother's Helps

Application Form for a Nanny / Mother's Help

Application Form for a
Housekeeper

Application Form for a Companion Caregiver

Before you complete this Form:

1) All applicants must be in the UK

2) You must have spoken to Norma Lewis on
07956 89 45 89

3) Your will need to have your papers ready