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Childminder
Adult care
About
Vacant Position
Contact Us
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Personal Details
Personal Details
Name
Email
Home Tel
Mobile Tel
Address
Postcode
Date of Birth
Driver
Yes
No
Full Manual Licence
Yes
No
Car Owner
Yes
No
Date of Test Pass
Do you have any Driving Convictions
Yes
No
Details of Driving Convictions
Driving Licence No.
Foreign Languages Spoken
Do you hold a current passport
Yes
No
Expiry Date
Passport No.
Do you have any Convictions
Yes
No
Details of Criminal Convictions
Do you hold a current Police Check
Yes
No
Police Check Issue Date
Are you on the DBS Update Service
Yes
No
Do you hold a First Aid Certificate
Yes
No
Certificate Issue Date
National Insurance No.
Step 2
Family Details
Next of Kin Name
Relationship to Next of Kin
Next of Kin Address
Next of Kin Home Tel
Next of Kin Mobile Tel
Step 3
Job Requirements
Job Type
Nanny
Nanny Housekeeper
Parent's Help
Maternity Nurse
Nursery Nurse
Babysitter
Permanent
Temporary
Full Time
Part Time
Live-in
Daily
Days/Hours Sought
Would you be happy to do additional babysitting
Yes
No
If you are seeking permanent work and are currently unemployed would you be happy to consider temporary work in a nursery
Yes
No
If you are seeking permanent work and are currently unemployed would you be happy to consider temporary work as a nanny
Yes
No
Preferred Locations
Distance Willing to Travel
Current Notice Period
Desired Start Date
Desired Finish Date
Salary Required
per
Hour
Day
Week
Month
Year
Gross or Net
Gross
Net
Is it essential that you are provided with a car
Essential
Preferred
Not Essential
Hobbies and Interests
Step 4
Acceptable Situations for Nannies
Sole Charge
Yes
No
Shared Charge
Yes
No
Sole Charge with Parent(s) working from home
Yes
No
Other (please specify)
Nursery Duties
Yes
No
Other (please specify)
Do you object to household pets
Yes
No
If 'Yes' Please specify
Step 5
Duties
Please indicate which of the following you are competent at:
Cook
Yes
No
Ski
Yes
No
Swim
Yes
No
Ride
Yes
No
Cycle
Yes
No
Sail
Yes
No
Sew
Yes
No
Reason for leaving
Submit
Personal Details
Upload Passport Size Photograph
Name
Email
Home Tel
Mobile Tel
Address
Postcode
Date of Birth
Driver
Yes
No
Full Manual Licence
Yes
No
Car Owner
Yes
No
Date of Test Pass
Do you have any Driving Convictions
Yes
No
Details of Driving Convictions
Driving Licence No.
Foreign Languages Spoken
Do you hold a current passport
Yes
No
Expiry Date
Passport No.
Do you have any Convictions
Yes
No
Details of Criminal Convictions
Do you hold a current Police Check
Yes
No
Police Check Issue Date
Are you on the DBS Update Service
Yes
No
Do you hold a First Aid Certificate
Yes
No
Certificate Issue Date
National Insurance No.
Step 2
Family Details
Next of Kin Name
Relationship to Next of Kin
Next of Kin Address
Next of Kin Home Tel
Next of Kin Mobile Tel
Step 3
Job Requirements
Job Type
Nanny
Nanny Housekeeper
Parent's Help
Maternity Nurse
Nursery Nurse
Babysitter
Permanent
Temporary
Full Time
Part Time
Live-in
Daily
Days/Hours Sought
Would you be happy to do additional babysitting
Yes
No
If you are seeking permanent work and are currently unemployed would you be happy to consider temporary work in a nursery
Yes
No
If you are seeking permanent work and are currently unemployed would you be happy to consider temporary work as a nanny
Yes
No
Preferred Locations
Distance Willing to Travel
Current Notice Period
Desired Start Date
Desired Finish Date
Salary Required
per
Hour
Day
Week
Month
Year
Gross or Net
Gross
Net
Is it essential that you are provided with a car
Essential
Preferred
Not Essential
Hobbies and Interests
Step 4
Acceptable Situations for Nannies
Sole Charge
Yes
No
Shared Charge
Yes
No
Sole Charge with Parent(s) working from home
Yes
No
Other (please specify)
Nursery Duties
Yes
No
Other (please specify)
Do you object to household pets
Yes
No
If 'Yes' Please specify
Step 5
Duties
Please indicate which of the following you are competent at:
Cook
Yes
No
Ski
Yes
No
Swim
Yes
No
Ride
Yes
No
Cycle
Yes
No
Sail
Yes
No
Sew
Yes
No
Step 6
Qualifications and Skills
Relevant Childcare Qualifications & Certificates (please include nursing/teaching etc)
Other Childcare Related Skills/Certificates
Do you have special needs experience
Yes
No
(please specify)
Step 7
Education and Training
School
Date
Address
Qualifications
College/University
Date
Address
Qualifications
Principal/Tutor
Details of any additional Courses/Qualifications
Step 8
Employment History
Please list your work history, including temporary and non-child related jobs starting with your present or most recent job
How many years of childcare experience have you had (including training)
# 1 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 2 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 3 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 4 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 5 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
Do you smoke, even socially
Yes
No
If vegetarian, are you willing to prepare and / or cook meat
Yes
No
How did you hear about us
Step 9
Declaration
I certify that the information given on this application form is true and correct and understand that if I have withheld any relevant information it may result in dismissal from any employment gained and termination from ROLAS Childminder and Adult Care Services. I allow ROLAS Childminder and Adult Care Services permission to use this information at their discretion, and to verify all references given. I understand that all information given to me regarding potential employers is confidential and I will not pass on any information including names, addresses and telephone numbers to any third parties. I agree not to introduce anyone else as possible employees to clients whose details I have obtained through ROLAS Childminder and Adult Care Services. In the event of possible permanent/temporary employment being offered by a client of ROLAS Childminder and Adult Care Services, I agree to notify the agency immediately and not to commence employment until confirmation is given.
Upload Your Signature
Submisstion Date
Submit
Serialized
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Personal Details
Upload Passport Size Photograph
Name
Email
Home Tel
Mobile Tel
Address
Postcode
Date of Birth
Driver
Select One
Yes
No
Full Manual Licence
Select One
Yes
No
Car Owner
Select One
Yes
No
Date of Test Pass
Do you have any Driving Convictions
Select One
Yes
No
Details of Driving Convictions
Driving Licence No.
Foreign Languages Spoken
Do you hold a current passport
Select One
Yes
No
Expiry Date
Passport No.
Do you have any Convictions
Select One
Yes
No
Details of Criminal Convictions
Do you hold a current Police Check
Select One
Yes
No
Police Check Issue Date
Are you on the DBS Update Service
Select One
Yes
No
Do you hold a First Aid Certificate
Select One
Yes
No
Certificate Issue Date
National Insurance No.
Family Details
Next of Kin Name
Relationship to Next of Kin
Next of Kin Address
Next of Kin Home Tel
Next of Kin Mobile Tel
Job Requirements
Job Type
Nanny
Nanny Housekeeper
Parent's Help
Maternity Nurse
Nursery Nurse
Babysitter
Permanent
Temporary
Full Time
Part Time
Live-in
Daily
Days/Hours Sought
Would you be happy to do additional babysitting
Select One
Yes
No
If you are seeking permanent work and are currently unemployed would you be happy to consider temporary work in a nursery
Select One
Yes
No
If you are seeking permanent work and are currently unemployed would you be happy to consider temporary work as a nanny
Select One
Yes
No
Preferred Locations
Distance Willing to Travel
Current Notice Period
Desired Start Date
Desired Finish Date
Salary Required
per
Select One
Hour
Day
Week
Month
Year
Gross or Net
Select One
Gross
Net
Is it essential that you are provided with a car
Select One
Essential
Preferred
Not Essential
Hobbies and Interests
Acceptable Situations for Nannies
Sole Charge
Select One
Yes
No
Shared Charge
Select One
Yes
No
Sole Charge with Parent(s) working from home
Select One
Yes
No
Other (please specify)
Nursery Duties
Select One
Yes
No
Other (please specify)
Do you object to household pets
Select One
Yes
No
If 'Yes' Please specify
Duties
Please indicate which of the following you are competent at:
Cook
Select One
Yes
No
Ski
Select One
Yes
No
Swim
Select One
Yes
No
Ride
Select One
Yes
No
Cycle
Select One
Yes
No
Sail
Select One
Yes
No
Sew
Select One
Yes
No
Qualifications and Skills
Relevant Childcare Qualifications & Certificates (please include nursing/teaching etc)
Other Childcare Related Skills/Certificates
Do you have special needs experience
Select One
Yes
No
(please specify)
Education and Training
School
Date
Address
Qualifications
College/University
Date
Address
Qualifications
Principal/Tutor
Details of any additional Courses/Qualifications
Employment History
Please list your work history, including temporary and non-child related jobs starting with your present or most recent job
How many years of childcare experience have you had (including training)
# 1 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Select One
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 2 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Select One
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 3 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Select One
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 4 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Select One
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
# 5 Experience
Employer Details
Name
Address
Work Tel
Home Tel
Email
Job Description
Post Held
Select One
Nanny
Nanny Housekeeper
Mother's Help
Maternity Nurse
Night Nanny
Nursery Nurse
Babysitter
Other (Please Specify)
Other
Start Date
End Date
Age of children at Start
Job Nature
Full Time
Part Time
Ad Hoc
Live-in
Daily
Permanent
Temporary
Sole Charge
Shared Charge
Reason for leaving
Do you smoke, even socially
Select One
Yes
No
If vegetarian, are you willing to prepare and / or cook meat
Select One
Yes
No
How did you hear about us
Declaration
I certify that the information given on this application form is true and correct and understand that if I have withheld any relevant information it may result in dismissal from any employment gained and termination from ROLAS Childminder and Adult Care Services. I allow ROLAS Childminder and Adult Care Services permission to use this information at their discretion, and to verify all references given. I understand that all information given to me regarding potential employers is confidential and I will not pass on any information including names, addresses and telephone numbers to any third parties. I agree not to introduce anyone else as possible employees to clients whose details I have obtained through ROLAS Childminder and Adult Care Services. In the event of possible permanent/temporary employment being offered by a client of ROLAS Childminder and Adult Care Services, I agree to notify the agency immediately and not to commence employment until confirmation is given.
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