client application form

Client Application Form

Nannies / Mothers Helpers

Please complete the following questionnaire and return to our office at your earliest convenience.

Name Last Name

Address & Postcode

Home Phone Work Phone

Mobile Fax

E-mail Address e.g.you@hotmail.com

Language spoken at home Other Languages

What specific type of carer do you require? Permanent or Casual

Nanny Mummy Nanny

Mothers Help Mother Craft Nurse Baby Sitter

Is this a (live-in) or (live-out) position?

If live-in, do you have a private bathroom /bedroom for the carer?

What experience/qualifications are you looking for in a carer?

What qualities are you looking for in a childcarer?

What hourly rate are you looking to offer?

What duties/hours/days will be required within this position?

How many children do you have?

What are their ages?

What sex are the children? M F

Do any of the children have special needs, if yes, please give details?

Do any of the children have any allergies, if yes, please give details

What housekeeping duties, if any, will you require?

Cooking for children only Ironing for children only Cooking for family

Laundry for children only Cleaning of children's areas

Grocery Shopping

HS4U recommends that your nanny is not responsible for the domestic chores, as their role of a nanny is primarily to provide a safe and stimulating environment for your children.

Starting date

What number would be best to reach you?

Will you be providing a car for work times? Yes No

If yes: Manual Automatic

Is this the first time you have employed a carer? Yes No

If no, please give reason why previous carer left

Do you have pets?Yes No

If yes, please give details

Any further information that you can provide to us in regards to your needs would be very helpful in us placing the right person for you.

ABN 58918362750

Many thanks for your time and interest in HS4U, we will contact you as soon as possible.