Housekeeper Form

Please complete this online form with as many details as possible to enable us to find a suitable placement for you.
Boxes with an asterisk * must be filled in.

Personal Details

Surname (family name): *

First Names: *

Address (house name/number and street):

Town/City:

Postal Code:

Country:

Phone Number (please include the country and area code): *

Mobile Number (please include the country and area code):

Skype:

Email Address: *

Nationality:

Height:

Weight:

Age:

Date of Birth:

Place of Birth:

Passport or Identity Card Number:

Recent photographs of yourself and/or with children and babies


Do you wish to be a housekeeper, or would you consider being an au pair, mother's help, or nanny?

housekeeperau pairmother's helpnanny

Would you prefer a live-in or live-out position?

live-inlive-out

When do you wish to commence employment?

Length of Employment:

Salary/Pocket Money Required:

FAMILY BACKGROUND

Father's Profession:

Mother's Profession:

Parent's Address: (if you are not living at home)

Parent's Phone Number: (if different from above)

Do you have any brothers or sisters?

YesNo

EDUCATION AND EMPLOYMENT DETAILS

Last School/College/University Attended:

Examinations/Qualifications Obtained:

How long have you studied English? (not applicable to British Nationals)

Is your English: Basic, fair, good or excellent?

FairGoodExcellent

Other languages spoken:

Please state whether your knowledge of any other spoken languages is: basic, fair, good, or excellent:

Current Occupation:

Length of notice to be given:

Previous Occupation:

Do you have any First Aid or CPR Certification?

YesNo

Do you have any other certificates? (certificates of merit, swimming, music, sports, etc.):

Do you have any formal childcare qualifications?

YesNo

If yes, which qualifications do you have?

EXPERIENCE WITH CHILDCARE, HOUSEWORK AND OTHER DETAILS

Please state if you are experienced or comfortable with childcare:

Please state if you are experienced or comfortable with housework:

Please state if you are willing to work with the following:

Infants (0-6 Months Old)Infants (6-12 Months Old)Children (1-2 Years Old)Children (2-5 Years Old)Children (5-10 Years Old)Families of a different raceFamilies with a single motherFamilies with a single father

If you have experience with children can you supply childcare references?

What type of housework have you done in the past?

Can you cook?

YesNo

If yes, please describe your level of expertise, and describe some dishes, etc., you can cook:

Are you in good health?

YesNo

If not, from what do you suffer?

Do you have any allergies?

YesNo

If yes, what allergies do you have?

Do you have a criminal record?

YesNo

If yes, what were you convicted of?

Do you eat everything?

YesNo

If no, what do you not eat, or what are your dietary restraints (such as religious restraints)?

Do you smoke?

YesNo

If yes, then how many per day?

Would you agree not to smoke in the family's home?

YesNo

Which sports do you play?

Do you play a musical instrument? And if so, which instrument?

Do you like animals?

If yes, which animals do you like?

Do you have a driving licence?

YesNo

If yes, please state the date you passed your test:

Would you drive abroad?

YesNo

Please give details of hobbies or interests, and/or any further information that you feel might help us find the right position for you:

DECLARATION

I fully understand the Agency's conditions, and agree to abide by these conditions. Furthermore, all the details given by me on this application form are correct.

I agree to the above declaration (please state that you agree): *

Electronic Signature: (please state your name): *

Additional items that you will be asked to send by post or e-mail when this form is positively processed:

  1. One pleasant passport photograph with your name on reverse.
  2. At least two large photographs showing you with children/babies (if not previously sent).
  3. A medical certificate stating you are fit to work with children.
  4. Two references will be required from previous employers with a phone number and e-mail address for each.
  5. If you have requested a nanny placement, copy of NNEB or similar certificates, should accompany your application form.
  6. A police record check.
  7. A “Dear Family” letter telling us about you, and any childcare and cleaning experience.

If you have any further pictures or scanned images or documents ready, as needed above, you may also e-mail these at the time you send the photographs to alison@crownaupairs.com
Femminilità sofisticata e strutturata quella espressa hogan outlet dalla nuova collezione borse Céline per la primavera hogan outlet online La collezione, affidata alla designer inglese Phoebe nike tn Philo, presenta borse a soffietto, alcune con i nike tn pas cher richiami glam secondo i trend di stagione, come pjs pas cher le borchie, ma anche particolari e originaliparajumpers pas cher maxi shopper rettangolari che siwoolrich outlet Ogni nuova collezione Chanel crea un’aspettativaoutlet woolrich online altissima che raramente viene delusa! è il caso delle golden goose saldi borse Chanel per la primavera estate 2017 della golden goose saldi La nuova collezione borse estive disegnata da Karl golden goose saldi Lagerfeld trascina le fashion addicted in un mondo golden goose saldi fantascientifico, parallelo e futurista, in cui le sac goyard pas cher bag dalle forme squadrate a volte diventano dei verisac goyard pas cher e propri mini robot. La storia dell’eleganza Chanelsac goyard pas cher s si mescola al futurismo quasi punksac goyard pas cher VERSACE BORSE 2017 NUOVA COLLEZIONEsac goyard pas cher Allure sporty per questa collezione, in gradoscarpe hogan outlet online però di non perdere mai di femminilità, scarpe hogan outlet online con borse funzionali che superano il scarpe hogan outlet online concetto di outfit da sera e da giornoscarpe hogan outlet online Le borse Versace primavera estate 2017 scarpe hogan outlet online sono a mano sono piccole, squadrate, scarpe hogan outlet online geometriche oppure maxi buste rettangolari. Non mancano i richiami glam fetish tanto cari alla stilista italiana, come le borchie e le catene, e i colori spazianopjs pas cher dal classico nero al rosso, dal giallo limone pjs pas cher Una collezione definita “lusso privato” dal pjs pas cher direttore creativo di Bottega Veneta, Tomas Maier.parajumpers pas cher I grandi marchi della moda stanno puntando sul lusso parajumpers pas cher funzionale e accessibile, dunque su borse e capi che parajumpers pas cher