Register as a Nanny

Register as an Au Pair

Full Name
Ref No (Office Use Only)
Post Required
If other, please give details
Start Date
Address (including postcode)
Email Address
Telephone number
Skype ID
Age and Date of Birth
If under 18 years, have you had any careers guidance?
Father's Occupation
Mother's Occupation
Age of brothers (if any)
Age of sisters (if any)


Please tick age groups Newborn3 Months - 1 Year1 Year - 3 Years3 Years - 5 Years5 Years - 7 Years+


Can you do any of the following: SwimCookDrive
Do you hold a full driving licence? YesNo
Do you own a car? YesNo
Make and Model
Have you done any first aid? YesNo
If so, what qualifications?
Other skills

Other Information

Do you smoke? YesNo
If you smoke, would you agree not to smoke in the house? YesNo
Which languages do you speak?
Do you suffer from homesickness?have any criminal convictions?have a police certificate?
Are you prepared to work anywhere? YesNo
If not, where are you prepared to work?
Are you willing to take a position that is DailyResidential
Do you require a special diet? If so, please give details.
Will you do light housework? YesNo
Will you work in a family where there are pets? YesNo
Are you willing to work with a single parent? YesNo
What salary do you expect?
What are your hobbies/interests?
Are you physically fit? YesNo
Please give details of any health problems or physical disabilities


Name of School/College
Start Date
End Date
Name of School/College
Start Date
End Date

Employment History

Name and Address of Employer
Position and age of children
Start Date
End Date
Reason for leaving
Net Salary


For immediate instructions to families we need two references

My referees will write directly to the agency YesNo

Reference 1

Relationship to you

Reference 2

Relationship to you

Agreement to Agency Terms

1. All interviews shall be arranged by the Agency and no arrangements may be made between potential employees and the clients unless authorised by the agency.
2. After an introduction, the Agency must be informed of all further developments.
3. Introduction of clients is confidential and must not be passed to any third parties.
4. The Agency does not insure workers against accident, or possible claims against third parties. Persons put forward by the agency are solely responsible for their own acts or omissions.
NB You are not employed by this Agency. You are employed directly by the people for whom you work.
Declaration: I declare that to the best of my knowledge the details given above are true and that I have read and agree to abide by the above conditions and rules of the Agency.

I Accept: Accept
Full name

If you would like a printed copy of this form, please click here