--------------------------------- Personal Details --------------------------------- Title (please select) Miss Mrs Ms Mr Other Name Address Date of Birth Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Daytime Number Evening Number Mobile Number Email Address --------------------------------- Qualification Details --------------------------------- Please provide your qualification(s) and year completed College Attended Are you OFSTED approved Yes No Number of Years Experience --------------------------------- Employment Requirements --------------------------------- Type of Work Required (please select all that are relevant) Daily Live In Part Time Full Time Permanent Temporary If Part time, please specify days and hours Dates Available from What Role are you seeking Preferred Ages of Children Salary Sought £ Requested working areas --------------------------------- Further Personal Details --------------------------------- Do you smoke? Yes No Do you drive? Yes No Do you own a car? Yes No Is sole charge essential? Yes No Do you have your own children? Yes No If yes, please give their ages and gender If yes, would you want to take them to work? Yes No Where did you hear about Playtime Nannies (please select) Previous contact Website Search Yellow Pages Recommended by Friend Other Additional Comments I confirm the information provided is is accurate at the time of completion of this form * Confirmed