BABYSITTER REGISTRATION

Please complete the following form, providing as much detail as possible.

PERSONAL DETAILS

Title Address
First Name  
Last Name Town
Maiden Name County
Mobile Tel. Postcode
Home Tel.
Work Tel. Nationality
Email Address Date of Birth
Confirm Email Age
Do you have children? Yes  No   If yes state ages
Childcare Qualifications NNEB  DCE  BTECH  NVQ2  NVQ3
  Other
Do you have a criminal record? Yes  No
Do you have a recent Criminal Records Bureau Disclosure? Yes  No
  If yes please state date of issue
Do you drive? Yes  No
Year of test
Any driving convictions? Yes  No
Car Owner? Yes  No
Are you willing to use your car at work (mileage paid)? Yes  No
Do you have a current first aid certificate? Yes  No
Do you smoke? Yes  No
Can you swim? Yes  No
Spoken Languages

English   French  German 
Spanish  Italian 
  Other

Additional Information

BABYSITTING REGISTER

Hourly babysitting rate
The following will be added to your online profile under the heading "A note from your babysitter" it is your chance to tell our clients a little about yourself, your qualities and strengths etc.

NANNY REGISTER

Would you like to be included on our nanny register? Yes  No
Employment Sought
Daily  Live In         Permanent  Temporary         Full Time  Part Time 
If temporary how long?
If part time select days available Mon  Tue  Weds  Thurs  Fri  Sat  Sun
When can you start?
Required salary (net per week)
Preferred number of children
Age range (years) to
Are you willing to do any of the following? Cooking: Yes  No
Light Housework: Yes  No
Any additional job requirements
Are you registered with the childcare approval scheme? Yes  No

MEDICAL

Do you have any condition that may effect you doing your job? Yes  No
  If yes please give details
Do you have any allergies? Yes  No
  If yes please give details
How many sick days have you taken in the last 12 months?

EDUCATION

Primary school
Secondary school
Further education  
College/University
Dates attended
Qualifications Achieved

EMPLOYMENT HISTORY

Current or most recent position  
Date started
Date left
Employers name
Address
Telephone
Number of children Girls   Boys
Ages Youngest   Eldest
Position held
Sole charge Yes  No
Reason for leaving
Do you have a written reference? Yes  No
Please use the following boxes to complete your employment history. (most recent first) Please include dates, names and addresses of employers, job description, number and ages of children and reasons for leaving.
Employment 1
Employment 2
Employment 3
Employment 4

REFEREES

Referee 1
Name
Relationship (eg employer/tutor)
Address
Telephone
Email
Can prospective employers contact this person? Yes  No
Referee 2
Name
Relationship (eg employer/tutor)
Address
Telephone
Email
Can prospective employers contact this person? Yes  No
Referee 3
Name
Relationship (eg employer/tutor)
Address
Telephone
Email
Can prospective employers contact this person? Yes  No

Where did you hear about us?
I confirm that the details I have provided in my application are true and accurate.

By submitting your registration form, you consent to Surrey Childcare passing any information, supplied by you, to prospective employers. This may be either verbally or written and may include contact details.

Please enter confirmation code