Full name of Father

Date of Birth

Marital status Married Single Cohabiting

Religion

Nationality

Profession

Full name of Mother

Date of birth

Marital status Married Single Cohabiting

Religion

Nationality

Profession

Main language at home

Other languages used

Address

Post Code

Home Phone

Work Phone

Mobile Phone

E-mail

Are parents home based? No Sometimes Yes

Name and ages of Children

Are you expecting a baby? No Yes

Additional information about Children

Do you have pets? Please specify

Please specify the need of your family Nanny - Live out Nanny - Live in Mothers Help - Live out Mothers Help - Live in Au Pair

Duties Sole Care School Run Organising Play Dates Cooking for Children Cleaning - Child Specific Cleaning - Light Household Cleaning - Heavy Household Supervising Home Work Household shopping - Light Household shopping - Heavy

Additional Duties

Days required to work Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Working hours daily

Working hours weekly

Job will start

Salary will be between

Driving requirements Driving not required Driving required

Live in accommodation Live Out Own Room Own TV Own Desk

Any further comments

Have you read Terms and Conditions? Yes No

Do you agree with Terms and Conditions? Yes No