--------------------------------- Personal Details --------------------------------- Title (please select) Miss Mrs Ms Mr Other Full Name * Address * Daytime Number * Evening Number * Mobile Number Email Address * Parents Occupation --------------------------------- Childcare Requirements --------------------------------- Type of Childcare Help Required (please select all that are relevant) Nanny Mothers Help Doula Temporary Live in proxy parent Nursery Nurse After School and Holiday care Temporary Holiday Work only Morning Work Afternoon work Living Arrangements (please select) Daily Live In If Live In, please select Own Room, Shared Bathroom Own Room, Own Bathroom Self Contained Annex Please specify Position required Permanent Full Time Temporary Full Time Permanent Part Time Temporary Part Time Will you consider a nanny with her own child to accompany her to your home Yes No Childrens Ages and Gender Baby Due Current Childcare Arrangements Special Requirements, ie. diet --------------------------------- Specific Details --------------------------------- Charge Sole Charge Shared Charge Will either parent be working from home Driver with Own Car? Yes No Is there a car provided on duty? Yes No Is there a car provided off duty Yes No Have you had a nanny before Yes No Do you require your nanny to have qualifications, please select No Qualifications Relevant Experience Experienced + Qualified Do you have any pets, if yes, please list them and note if they are long or short haired Start Date --------------------------------- Hours of Employment --------------------------------- Please note the expected Start and Finish times below Monday Tuesday Wednesday Thursay Friday Saturday Sunday --------------------------------- Expected Duties --------------------------------- Nursery Duties Yes No School Runs Yes No Cooking Yes No Light Housework Yes No Pet Care Yes No Babysitting Yes No Holiday with Family Yes No Do you employ any other domestic help? --------------------------------- Salary --------------------------------- Indication of pay per hour or, per week Please state Net or Gross Net Gross Will you be claiming tax credits or childcare vouchers Yes No Where did you hear about Playtime Nannies (please select) Previous contact Website Search Yellow Pages Recommended by Friend Other Additional Comments I have read and agree with the Terms and Conditions * Confirmed