Personal Details
Please complete all fields
   
First Name: 
   
Last Name: 
   
Current Address: 
   
Permanent Address: 
   
Mobile Telephone: 
   
Home Telephone: 
   
Daytime Telephone: 
   
Email Address: 
   
Nationality: 
   
Date of Birth: 
   
Maritial Status: 
   
Dependants: 
  Yes:    No:
   
Next of Kin: 
   
Next of Kin Tel: 
   
Criminal Convictions: 
  Yes:    No:
   
Non-Smoker: 
  Yes:    No:
   
Driving Ability: 
 Own Car: Full Licence: Provisional:    Learning: Cannot Drive:
   
Other: 
  Creative: Musical: Swimmer:
   Sporty: Willing to Travel with Family:
   
Detail Hobbies & Intrests: 
   
  Education
Please complete all fields
   

Secondary School: 
   

Address: 
   
From/To: 
 to
   
Award: 
   

Third Level College: 
   
Address: 
   

From/To: 

 to
   

Award: 
   
Other College 1: 
   

Address: 
   

From/To: 

 to
   

Award: 

 

  

Other College 2: 
   

Address: 
   

From/To: 

 to
   

Award: 

 

  
  Work History
Please complete all fields
 Starting with the most recent 
  
Name: 
 
Address: 
 
Email: 
 
Tel: 
 
From/To: 
 to
 
Position Held: 
 
Number of Children: 
 
Age at Start of Contract: 
 
Reason for Leaving: 
 
Name: 
 
Address: 
 
Email: 
 
Tel: 
 
From/To: 
 to
 
Position Held: 
 
Number of Children: 
 
Age at Start of Contract: 
 
Reason for Leaving: 
 
Name: 
 
Address: 
 
Email: 
 
Tel: 
 
From/To: 
 to
 
Position Held: 
 
Number of Children: 
 
Age at Start of Contract: 
 
Reason for Leaving: 
   
Name: 
 
Address: 
 
Email: 
 
Tel: 
 
From/To: 
 to
 
Position Held: 
 
Number of Children: 
 
Age at Start of Contract: 
 
Reason for Leaving: 
   
Name: 
 
Address: 
 
Email: 
 
Tel: 
 
From/To: 
 to
 
Position Held: 
 
Number of Children: 
 
Age at Start of Contract: 
 
Reason for Leaving: 
   
Name: 
 
Address: 
 
Email: 
 
Tel: 
 
From/To: 
 to
 
Position Held: 
 
Number of Children: 
 
Age at Start of Contract: 
 
Reason for Leaving: 
   

 

  
  Position Details
Please complete all fields
 
*Perferred Position: 
   
Job Type: 
  Perm: Temp: Full-Time:
 Part-Time: Sole Charge: Shared Care:
   
Start Date: 
   
Finish Date (if temp): 
   
Weekly Daily Hours: 
  Yes:    No:
   
Preferred Times: 
   
Evenings: 
  Yes:    No:
   
Number per Week: 
   
Night Cover (8pm-8am): 
  Yes:    No:
   
Number per Week: 
   
Weekends: 
  Yes:    No:
   
Number per Month: 
   
Max Number of Children: 
   
Age Range of Children: 
   
Perferred Location: 
   
     Gross Salary: 
   

Hourly Rate (if temp): 
   

Overtime Rate:

   
Attach Resume: 
  
or
  
Paste Resume: 

   

How did you hear of us: 
   
Declaration: I certify that all information contained within this application form is authentic and accurate. I give my consent to Executive Nannies to verify this information. I undertake that should I take a position directly or indirectly through Executive Nannies or be re-engaged by a client of Executive Nannies, I will notify the agency immediately. I acknowledge that any information given to me about potential employers is highly confidential and I agree not to divulge such information to anyone without consent.
I accept: