Rainbow Nanny Agency & Domestic Agency - specialists in the placement of nanny agencies, Nursery Staff, Housekeepers, Mothers Help and Childminders. Vacancies required for Creche, Nurseries, Day Care, Afterschool Care, Kindergarten and Playgroups

STAFF REGISTRATION FORM
PERSONAL DETAILS (Please tick/select where appropriate)
Name :		Telephone :
Address :		D.O.B. :
		Marital Status :

No. of own children :		Ages (if applicable) :
Religion :		Ethnic Origin :
Next of Kin :

EDUCATION AND EXPERIENCE
Experience :
Qualifications :
Where were Qualifications gained ? :
Details of last or present post held :
Reason for leaving current position :

TYPE OF PLACEMENT REQUIRED (Please tick where appropriate)
POSITION	AGE OF CHILDREN	DURATION	OTHER
Nanny	Babies	Full Time	Live-In
Mothers Help	1-2 yrs	Part-time	Live-Out
Housekeeper	3-5 yrs	Temporary	Nursery Duties Only
Babysitter	Over 5 yrs	Emergency	Housework not objected to
Nursery	Any Age	Holidays Only
Elderly

OTHER INFORMATION
Date available to start work :		Are you prepared to travel to work? :	Yes No
Please state areas for live out :
Maximum distance :	miles	Do you have own transport ? :	Yes No
Do you have a clean driving licence ? :	Yes No
Salary required per week (nett) :	Ł	Per hour (nett) :	Ł

HEALTH (Please tick where appropriate)
Are you in good health ? :	Yes No	Do you smoke ? :	Yes No
Are you at present receiving treatment from a doctor/hospital ? :	Yes No	If Yes, please give details :
Have you ever suffered from any of the following ? :	Epilepsy Tuberculosis Anxiety Depression	If Yes, please give dates :
Do you suffer from any other serious illness ? :	Yes No	If Yes, please give details :
Are you registered disabled ? :	Yes No	Can we contact your doctor ? :	Yes No
Name and Address of your doctor :

CRIMINAL CONVICTIONS
In order to protect young persons the rehabilitation of offenders act 1974 (exception order 1995) does not allow employees with access to children and any young person under 18 years the right to withhold information regarding previous criminal co nvictions.
Have you any criminal convictions ? :	Yes No	If Yes, please give details :
Have you a current CRB check ? :	Yes No	If Yes, please give date/s :

HOBBIES
Please give below details of any hobbies or special interests you have :

REFERENCES
Please give below the names and addresses where two references can be obtained :
Name :		Name :
Address :		Address :

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