childcarerform

Cupcakes Nanny Agency
Childcarer's Registration Form

Title:

Full Name:

Full Address & Post Code:

Home Telephone:

Mobile Telephone:

E-mail Address:

Employment Details:

Nursery Work

Nanny

Doula

Maternity Nurse

Mother's Help

Housekeeper

Babysitter

Full or Part Time?

Perm or Temp?

Relevant Qualifications

Years of professional
childcare experience
working in a private home

Years of professional
childcare experience
working in a nursery

CRB Certificate < 12
months old? Yes or No

Do you require a new CRB
check through Cupcakes?
Yes or No

First Aid Certificate < 12
months old? Yes or No

Are you an Ofsted registered nanny so that families may claim
tax credits or childcare vouchers? Yes or No

Do you need advice on Ofsted registration? Yes or No

Which Days Per Week:

Friday

Monday

Tuesday

Saturday

Wednesday

Sunday

Thursday

Max Hours Per Day

Live in or Live Out?

Salary Sought:

Note. For Babysitting only, the agency has set a
standard babysitter's fee of £7 per hour up to
midnight and £8 thereafter.

Available Now?

No of weeks notice required from
current position

Do you drive?

Do you have a clean driving
licence?

If not, please state date,
offence code and points

Any additional information or
requirements

Please provide 2 relevant references - ideally both from childcare positions or at least 1
from a childcare position and 1 from college. References from any current employer will
not be taken up until notice is handed in. Please can you supply email addresses
for referees if you have them.

Reference 2

Reference 1

To help us with our marketing, please tell us how you found out about Cupcakes?

Google sponsored ad

Through Nanny Job

Google search engine

Through Nanny's Helping Hand

Yahoo search engine

Through Gumtree

Recommendation

MSN search engine

If Other, please identify

PLEASE REMEMBER TO SIGN UP TO OUR DAILY JOB ALERTS.

The declaration below must be agreed by all applicants before they can be interviewed by
Cupcakes or any prospective employers. If an applicant holds an old Criminal Records
Check, they will need to arrange for an The ability to use an old Criminal Records Check
lies solely with Cupcakes or the prospective employer. Applicant will not be discriminated
for reasons of sex, age, race or disability. Under the Data Protection Act 1998, we are
obliged to inform you that we hold information about your application on a database and
you are entitled to view this data yourself when you request it in writing. (A charge may be
required for administration). Data Protection Registration No. Z1554594.

DECLARATION
I declare that the information given above is, to the best of my knowledge, true and
correct and that misleading statements may be sufficient for cancelling any agreements
made.

Owing to the nature of the duties within the job I may be appointed to I also understand
that I will be asked to sign a declaration which will include details of any criminal
convictions, cautions, reprimands and final warnings and any other information that may
have a bearing on my suitability for the post.

I understand that an Enhanced Disclosure may be sought in the event of my application
to the agency being successful.

I give my permission for members of staff at Cupcakes to discuss with any prospective
employers information which has been given on this application form, within my CV, CRB
check, any further information given as written or verbal references and anything
discussed during my interview or in subsequent telephone conversations with Cupcakes
staff.

I have read, understand and agree with the Declaration above:

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