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1. Please state if one parent household Yes No
4. Do you have any pets? Yes No If YES, please give details:
5. Is there any other person living in the house (other than own children)? Yes No If YES, please give details:
Is there a new baby on the way? Yes No
1. What type of help is required? 24 Hour Maternity Nurse Day Maternity Nurse 24 Hour Maternity Nurse
5. Will the Maternity Nurse be expected to live in? Yes No If YES, will they have their own room or will they be sleeping in the nursery
6. Salary range offered or specific salary: (Please state whether net or gross)
7. How will this be paid and how often?
Any further comments?
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 employee. The representatives may share this information between themselves and with potential employees. As far as possible, they will keep this information confidential and secure. However, clients should be aware that Wentworth Nannies may be required by law or regulatory authority to disclose this information in certain circumstances.