Nannies and Nanny/Housekeepers - Request Form

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Your Details












Your Household

1. Please state if one parent household Yes  No 


and is he at home during the day? Yes  No 


and is she at home during the day? 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:

6. Describe your family home e.g. No bedrooms, reception rooms, bathrooms, facilities e.g. pool, distance to local shops.

7. Any other type of help employed (please specify)?

8. Is any business carried on at the premises? Yes  No 


Your Children



Is there a new baby on the way? Yes  No 

Age
Any other relevant information e.g. allergies etc
Age
Any other relevant information e.g. allergies etc
Age
Any other relevant information e.g. allergies etc
Age
Any other relevant information e.g. allergies etc
Age
Any other relevant information e.g. allergies etc


Help Required

1. What type of help is required?







4. Any special qualifications required?

5. Any other special requirements?

6. Do you require a person who does not smoke? Yes  No 

7. Do you require a person who can cook? Yes  No 

8. Do you require a person who can swim? Yes  No 

9. Do you require a person who can driver? Yes  No 

10. Is a car available for the person's use? Yes  No 

11. Will person be given sole charge of children for any long periods (e.g. overnight)? Yes  No  If YES, please give details:

12. What are the family’s hobbies and interests?

13. Will person be expected to share hobbies and interests? Yes  No 

14. Will person be expected to share your religion? Yes  No 

15. Duties of person:

16. Free time given

17. Is person expected to go on holiday or business trips with you? Yes  No 
If YES, please give details of any in the near future:

18. Salary range offered or specific salary: (Please state whether net or gross)

19. How will this be paid and how often?


Live-Out Position Only complete this section if you are requesting a LIVE-IN position.

1. Will you require the person on a daily basis? Yes  No 

2. How frequently and for how long on each occasion will you require their services (e.g. three days a week for three hours at a time)?


Live-In Position
Only complete this section if you are requesting a LIVE-OUT position.

1. Is the accomodation self-contained (eg flat) or own room? Self-Contained  Own Room 

2. If SELF-CONTAINED, please give details (including number of rooms):


3. If OWN ROOM, please give details (including size of room):


4. If OWN ROOM, will the person have their own bathroom? Yes  No 

5. Will the person have his or her own television set? Yes  No 

6. Is the accomodation furnished? Yes  No 

7. Does it have its own separate entrance other than through the main house? Yes  No 

8. Any other comments (i.e. perks etc.):


Finally

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.