Childcarers Registration

* Indicates the mandatory fields.

Your Details
Title*
First Name*
Last Name*
Address 1*
Address 2
Town / Village*
County*
Postcode*
Telephone*
Mobile
Email*
Confirm Email*
Date of Birth*
Age*
Nationality*
Marital Status
Maiden Name
Dependants and ages


Are you seeking a position which will allow you to take your child to work with you? Yes No

Do you have back up childcare arrangements in place? Yes No

Please provide any further details which you feel may be relevant


Education and Experience
Secondary School Attended*
Year attended from*
Year attended to*
Number of GCSE's taken. Grades A-C* 0 1 2 3 4 5 6 7 8 9 10
Grades C+ * 0 1 2 3 4 5 6 7 8 9 10

College Attended*
Year attended from*
Year attended to*

Childcare Qualifications*
NNEB NAMCW CACHE2 CACHE3 NVQ2 NVQ3 BTEC MNT None of these

Please state any other qualifications

Do you hold a Food Hygiene Certificate?* Yes No
How many years Childcare experience do you have?* 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+
How many years Sole Charge experience do you have? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+
Ages of children you have had sole charge of?
0-3 months 3-6 months 6-12 months 1-3 years 3-5 years 5-11 years 11 years+

Have you cared for multiple births before? Twins Triplets
Have you cared for a child with Special Needs before?* Yes No
Have you cared for a child that has special dietary requirements before?* Yes No

Do you hold a Criminal Records Beauru (CRB) Enhanced Disclosure?* Yes No

Date of issue if held

Please note: To register with Elizabeth Henry Nannies you are required to hold a CRB Enhanced Disclosure. We can arrange this for you should you not already have one.


Do you hold a Peadiatric First Aid Certificate?* Yes No
Date of issue if held
Are you currently Ofsted Registered?* Yes No
Date of Registration
Are you willing to become Ofsted approved?* Yes No
Do you drive?* Yes No
Do you own a car?* Yes No
Are you willing to use your own car for work purposes?* Maybe Yes No
Do you hold a clean driving Licence?* Yes No

If no to any of the above questions please provide details


Current Employment Details
Are you currently employed?* Yes No
If yes, when did you start?
If no, when did you leave?
If you are looking to hand in your notice, how long is your notice period?

What date are you available to start work?
What position do you currently hold*
None Nanny Mothers Help Nursery Nurse Other (please state below)

Other postion

If you are working as a Nursery Nurse which rooms are you currently working in?
Baby room Toddler room Pre School room After school care

Ages of children currently Nanny for?	Gender	Age
Child 1	Boy Girl	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16+
Child 2	Boy Girl	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16+
Child 3	Boy Girl	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16+
Child 4	Boy Girl	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16+

If the options above do not explain your current employment please provide details here


Job Requirements
What type of position are you looking for?*
Full time Part time Temporary Sole charge Nanny Mothers help Baby sitting
Maternity Nurse Night Nanny After school care Nanny / Housekeeper Special Needs Nanny
Occasional Care

Days Required*
Mon Tue Wed Thu Fri Sat Sun
Hours prepared to work? eg 7am to 7pm*

Are you available for ad hoc evening babysitting?
Weekends only Weekdays only Weekdays and Weekends
From what time?

What duties are you willing to perform?*
All house work Light house work Childrens rooms only Pet care Family laundry
Childrens laundry Dog walking Family shopping Ironing

What is your preffered age range?*
0-3 months 3-6 months 6-12 months 1-3 years 3-5 years 5-11 years 11 years+

Maximum number of children to care for?* 1 2 3 4 No limit

Would you consider working for a family where a parent works from home?*

Would you be happy caring for a child with special needs or a disability?* Yes No

Please specify your required net weekly salary or hourly rate

Please indicate which areas you are willing to work:


Would you be interested in working as a temporary nanny / mother’s help in between jobs?* Yes No

Do you smoke?* Yes No
Are you willing to work for a smoking family?* Yes No
Can you swim?* Yes No
Do you play a musical Instrument?* Yes No
If so which instrument
Do you speak a foreign language?* Yes No
If so which language
Do you play a sport?* Yes No
If so which sport
Are you happy to cook meat for a family?* Yes No
Do you have any allergies or phobia's that could affect you at work?* Yes No

Please give details


Please use the space below to list any hobbies or interests you have, please list at least three*


Medical History
Do you have or have you had in the last 5 years had any physical problems requiring specialist Referral?* Yes No

Do you have or have you had any mental health problems in the last 5 years?* Yes No

Have you, at any time, suffered from mental or physical health problems which could affect your ability to work as a childcarer with sole charge of young children?* Yes No


Are you taking any regular prescribed medicines?* Yes No

Do you have any medical requirements which may effect your work?* Yes No


If you have answered yes to any of the above please give details below


Where possible please attach your current C.V. here
Please note that attaching your current CV here will help speed up the process of your registration

I certify that the above information is correct.  I understand that all information passed to myself from Elizabeth Henry Nannies with regards to prospective employers is to be treated in the strictist of confidence and must not be passed on to a third party.

Tick here to confirm you agree to the above statement I Agree