Maternity Nurse - Application form

Please note - Incomplete forms may result in a delay in processing.

If you would prefer to print out this form and return to us in the post then please click here.

Your Details













Your Availability

1. Please state any time that you would not be available for employment (e.g. the mornings/afternoons/days you do not wish to work if part-time):



5. Please state the areas you are prepared to work:


About You

1. Are you prepared to work with special needs children? Yes  No 

2. Are you prepared to work in a household with animals? Yes  No 
If NO, please state which animals are unacceptable:

3. Do you smoke? Yes  No 
If YES, would you expect to smoke during working hours? Yes  No 

4. Do you hold a current, clean driving licence? Yes  No 
If YES, do you have your own vehicle? Yes  No 
If NO, do you wish to have use of a car, if possible? Yes  No 

5. Have you had any serious illnesses other than the usual childhood ailments? Yes  No 
If YES, please give details:

6. Do you have any allergies? Yes  No 
If YES, please give details:

7. Do you have diabetes? Yes  No 

8. Please state any hobbies or interests that you have:


Your Experience and Qualifications

1. Please enter any previous employment whether full-time, part-time or temporary:

2. Secondary Level Education

3. Further Education

4. Certificates (e.g. CRB, First Aid, NVQ etc):

5. Please state any previous, relevant experience gained::


References

Please enter the names and addresses of two people who are willing to provide references for you. They must NOT be relatives and at least one should be that of a previous employer. We may contact your referees when processing your application.











Finally

6. Have you ever been convicted of a criminal offence? Yes  No 
If YES, please give details:

How did you hear about us?

Data Protection In completing this form you will be disclosing personal information to representatives of Wentworth Nannies to enable them to determine a suitable employer. The representatives may share this information between themselves and with potential employers. As far as possible, they will keep this information confidential and secure. However, applicants should be aware that Wentworth Nannies may be required by law or regulatory authority to disclose this information in certain circumstances.