Family Registration Form For A Nanny, Mother's Help (Live In / Out)

Family Registration Form for a Nanny or Mother's Help

Personal Details

Full Name and Title *

Address *

Postcode *

Home Telephone Number *

Mobile Phone Number *

Work Telephone Number

E-Mail *

Family Details

Mother and Fathers Marital Status Single
Married
Divorced
Widowed

Fathers age

Fathers nationality

Fathers religion

Fathers occupation

Mothers age

Mothers nationality

Mothers religion

Mothers occupation

Names, Sex and Ages of Children

Newborn baby due Yes
No

Do you or your children have any medical conditions, or any other specific special needs?

What are your families hobbies and interests?

Internet Yes
No

Computer games Yes
No

Music Yes
No

Walking Yes
No

Cycling Yes
No

Horseriding Yes
No

Swimming Yes
No

Cinema Yes
No

Reading Yes
No

Which sports do your family enjoy?

Any other interests or after school activities

Do you have any pets? Yes
No

If so what are they

Do you require the Nanny/Mothers Help to assist with the care of the pets Yes
No

How?

What do you want from your Nanny / Mothers Help?

Do you need a Nanny
Mothers Help
Either

Do you want someone to Live-in
Live-out
Either

When do you need a Nanny/Mothers help to start

How long would you like them to stay

Will you accept a smoker? Yes
No

If Yes are there any restrictions

Do you need a driver? Yes
No

If yes, for what types of journeys?

Will the Nanny/Mothers Help be allowed use of the car for themselves? Yes
No

Is the car Manual
Automatic

Do you confirm that you are responsible for

Providing a roadworthy vehicle with full tax, insurance and MOT Yes
No

Ensuring the Nanny/Mothers Help has the standard of driving you require Yes
No

Duties you would expect from your Nanny / Mothers Help

Childcare Yes
No

Housework Yes
No

Sole charge Yes
No

Cleaning Yes
No

Playing with children Yes
No

Hoovering Yes
No

Feeding babies Yes
No

Dusting Yes
No

Simple cooking Yes
No

Washing / ironing Yes
No

Taking to / collecting from school Yes
No

Bed making Yes
No

Babysitting Yes
No

Do you employ any other help Yes
No

How many days and which hours do you require you Nanny/Mothers Help to work

Please provide a timetable of a typical days duties for your Nanny/Mothers Help

Would the Nanny/Mothers Help be required to travel with you Yes
No

If Yes Within Europe
Worldwide

Your home and area

Where is your home? Village
City Suburb
City Centre

Is your home: Detached
Semi Detached
Terraced
Flat

How many bedrooms?

How many bathrooms?

Does it have a garden? Yes
No

Computer / internet facilities? Yes
No

Is it wireless internet Yes
No

May the Nanny/Mothers Help use these facilities Yes
No

May the Nanny/Mothers Help have friends in your home Yes
No

Describe your Nanny/Mothers Helps accommmodation if applicable

How long does it take to get to the following by Walking, Bus or Train/Tube?

Local shops

Bus stop

Train / Underground

Main shopping centre

Library

Restaurants

Pubs and Bars

Museums

Cafes and Restaurants

Night Clubs

Which is your nearest airport and train or tube station

Salary

What are you willing to pay your Nanny /Mothers Help (Net)

How many weeks paid holiday p.a.

Do you understand that you are liable for her tax and N.I contributions? Yes
No

And Finally...

Please describe your family and household - e.g. "we are a friendly but hectic household..."

Would you like any information on first aid courses for your Nanny / Mothers Help Yes
No

How did you hear about Norma Lewis Domestic Staff? *

Are you registered with any other agencies and if so which ones?

Have you previously employed a Nanny Yes
No

Acceptance of terms and conditions

Terms and Conditions Link

NOW THIS FORM IS COMPLETED, PLEASE ENSURE YOU HAVE READ AND UNDERSTOOD THE "FEES" AND THE "TERMS AND CONDITIONS OF BUSINESS" OF NORMA LEWIS DOMESTIC STAFF AGENCY. (YOU SHOULD KEEP ONE COPY OF THESE FOR YOUR OWN RECORDS).
SUBMITTING THIS COMPLETED FAMILY REGISTRATION FORM IN ANY FORMAT TO NORMA LEWIS DOMESTIC STAFF AGENCY SHOWS ACCEPTANCE OF THESE TERMS.

Family Name *

Date *

GENERAL INFORMATION

FOR APPLICANTS

FOR FAMILIES