Application Form
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Littluns Childcare ©
13 Seend Cleeve, Melksham, Wiltshire, SN12 6PS APPLICATION FORM Please fill in in BLOCK CAPITALS in blue or black ink
Position Applied For:
PERSONAL INFORMATION Surname First Names Date Of Birth Address
Postcode Home Tel Mobile Email
EDUCATION University/College Address
Dates Attended
Subjects & Grades Achieved
Secondary School Address
Dates Attended Subjects & Grades Achieved
EMPLOYMENT HISTORY (Continue on a separate sheet if necessary) 1. Employers Address Position Held
Salary
Responsibilities
Dates Employed
From:
To:
Reason for Leaving
2. Employers Address
Position Held
Salary
Reason for leaving
Responsibilities
Dates Employed
From:
To:
3. Employers Address
Position Held
Salary
Reason for leaving
Responsibilities
Dates Employed
From:
To:
PERSONAL STATEMENT Please write a short statement about yourself. Please include the following • Hobbies and interests • Reasons for applying • Your goals and targets for the next year • Where you see yourself in 10 years time This is your chance to really sell yourself and set yourself apart from other applicants so really go for it. The more we find out about you and your personality the better J Continue on a separate sheet if necessary. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ References Employers Name
Position
Address
Contact Telephone Number
Postcode
Reason For Leaving
May we contact your employer prior to interview?
Yes
No
If no please give a reason why
Employers Name
Position
Address
Contact Telephone Number
Postcode
Reason For Leaving
May we contact your employer prior to interview?
Yes
If no please give a reason why
No
Employers Name
Position
Address
Contact Telephone Number
Postcode
Reason For Leaving
May we contact your employer prior to interview?
Yes
If no please give a reason why
No
Supporting Information Which animals are you happy for your family to have? Cat Dog Rabbit Small animal (Hamsters etc) Yes
No
Yes No
Yes No
Yes No
Other
Yes
No
Which of the following would you be happy to do? Children’s Cooking
Yes No
Tidy Children’s Rooms
Yes
No
Family Cooking
Yes No Yes No
Food Shopping
Yes
No
School/Nursery Runs
Yes
No
Children’s Washing
Yes No
Activity Runs (Ballet etc)
Yes
No
Family Washing
Yes No
Out Of House Babysitting
Yes
No
Washing Up
Yes No
Host Play Dates
Yes
No
Walk dog/s
Do you/have you suffer from any of the following? (Please note the answers to these questions will NOT affect your application, families just prefer to in advance) Asthma
Yes
No
Skin Condition
Yes
No
Epilepsy
Yes
No
Memory Loss
Yes
No
Fainting Attacks
Yes
No
Other (Please state)
Heart Condition
Yes
No
If you have answered yes to any of the above questions and the condition is current please can you tell us below what medication you are on…. _________________________________________________________________ Do you….
Smoke Drink
Yes
No
Yes No If Yes how may units per week on average 1-10 11-20 More than 20
If you aren’t applying for a specific vacancy or in if you are not successful in your application for a specific vacancy then it helps us to know exactly what you are looking for and what your experiences are. REQUIREMENTS What type of work are you looking for?
Nanny Au Pair
Babysitter Other
Mothers Help
What hours are you looking for?
Full Time Part Time Term Time Only
Where are you looking to work?
Within Within Within Within
a a a a
5 mile radius of my postcode 10 mile radius of my postcode 15 mile radius of my postcode 20 mile radius of my postcode
Anywhere in Wiltshire Do you wish to….
Live in
What is your preferred age range?
Newborn Baby Young Adult Any
How many years experience do you have in childcare?
Less than 1 3-5 Years
How many children are you willing to look after at any one time?
1
What is your preferred method of care?
Sole Charge
Live Out
2
Either Toddler
Child
1-2 Years 2-3Years More than 5 years 3
4
More Than 4
Shared Care
Either
You may have already answered these questions on our previous pages but please answer the questions below Do you have or have you ever had any of the following? Full UK driving licence?
Yes
No
Your own vehicle?
Yes
No
An enhanced CRB?
Yes
No
A standard CRB?
Yes
Is it clean?
Yes
No
No
Any criminal convictions?
Yes
No
If yes please give details below
First aid certificate?
Yes
No
Is it current?
Yes
No
Food Hygiene certificate?
Yes
No
Is it current
Yes
No
Details of any driving convictions with dates _________________________________________________________________________________ Details of any criminal convictions with dates (Including cautions) _________________________________________________________________________________
I can confirm that to the best of my knowledge the information I have given in correct. I accept that providing deliberately false information could result in my dismissal Signature _____________________ Date_____________ Print Name ____________________________ PLEASE RETURN COMPLETED APPLICATION FORM TO: LITTLUNS CHILDCARE 13 SEEND CLEEVE MELKSHAM WILTSHIRE SN12 6PS Many thanks
13 Seend Cleeve, Melksham, Wiltshire, SN12 6PS APPLICATION FORM Please fill in in BLOCK CAPITALS in blue or black ink
Position Applied For:
PERSONAL INFORMATION Surname First Names Date Of Birth Address
Postcode Home Tel Mobile Email
EDUCATION University/College Address
Dates Attended
Subjects & Grades Achieved
Secondary School Address
Dates Attended Subjects & Grades Achieved
EMPLOYMENT HISTORY (Continue on a separate sheet if necessary) 1. Employers Address Position Held
Salary
Responsibilities
Dates Employed
From:
To:
Reason for Leaving
2. Employers Address
Position Held
Salary
Reason for leaving
Responsibilities
Dates Employed
From:
To:
3. Employers Address
Position Held
Salary
Reason for leaving
Responsibilities
Dates Employed
From:
To:
PERSONAL STATEMENT Please write a short statement about yourself. Please include the following • Hobbies and interests • Reasons for applying • Your goals and targets for the next year • Where you see yourself in 10 years time This is your chance to really sell yourself and set yourself apart from other applicants so really go for it. The more we find out about you and your personality the better J Continue on a separate sheet if necessary. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ References Employers Name
Position
Address
Contact Telephone Number
Postcode
Reason For Leaving
May we contact your employer prior to interview?
Yes
No
If no please give a reason why
Employers Name
Position
Address
Contact Telephone Number
Postcode
Reason For Leaving
May we contact your employer prior to interview?
Yes
If no please give a reason why
No
Employers Name
Position
Address
Contact Telephone Number
Postcode
Reason For Leaving
May we contact your employer prior to interview?
Yes
If no please give a reason why
No
Supporting Information Which animals are you happy for your family to have? Cat Dog Rabbit Small animal (Hamsters etc) Yes
No
Yes No
Yes No
Yes No
Other
Yes
No
Which of the following would you be happy to do? Children’s Cooking
Yes No
Tidy Children’s Rooms
Yes
No
Family Cooking
Yes No Yes No
Food Shopping
Yes
No
School/Nursery Runs
Yes
No
Children’s Washing
Yes No
Activity Runs (Ballet etc)
Yes
No
Family Washing
Yes No
Out Of House Babysitting
Yes
No
Washing Up
Yes No
Host Play Dates
Yes
No
Walk dog/s
Do you/have you suffer from any of the following? (Please note the answers to these questions will NOT affect your application, families just prefer to in advance) Asthma
Yes
No
Skin Condition
Yes
No
Epilepsy
Yes
No
Memory Loss
Yes
No
Fainting Attacks
Yes
No
Other (Please state)
Heart Condition
Yes
No
If you have answered yes to any of the above questions and the condition is current please can you tell us below what medication you are on…. _________________________________________________________________ Do you….
Smoke Drink
Yes
No
Yes No If Yes how may units per week on average 1-10 11-20 More than 20
If you aren’t applying for a specific vacancy or in if you are not successful in your application for a specific vacancy then it helps us to know exactly what you are looking for and what your experiences are. REQUIREMENTS What type of work are you looking for?
Nanny Au Pair
Babysitter Other
Mothers Help
What hours are you looking for?
Full Time Part Time Term Time Only
Where are you looking to work?
Within Within Within Within
a a a a
5 mile radius of my postcode 10 mile radius of my postcode 15 mile radius of my postcode 20 mile radius of my postcode
Anywhere in Wiltshire Do you wish to….
Live in
What is your preferred age range?
Newborn Baby Young Adult Any
How many years experience do you have in childcare?
Less than 1 3-5 Years
How many children are you willing to look after at any one time?
1
What is your preferred method of care?
Sole Charge
Live Out
2
Either Toddler
Child
1-2 Years 2-3Years More than 5 years 3
4
More Than 4
Shared Care
Either
You may have already answered these questions on our previous pages but please answer the questions below Do you have or have you ever had any of the following? Full UK driving licence?
Yes
No
Your own vehicle?
Yes
No
An enhanced CRB?
Yes
No
A standard CRB?
Yes
Is it clean?
Yes
No
No
Any criminal convictions?
Yes
No
If yes please give details below
First aid certificate?
Yes
No
Is it current?
Yes
No
Food Hygiene certificate?
Yes
No
Is it current
Yes
No
Details of any driving convictions with dates _________________________________________________________________________________ Details of any criminal convictions with dates (Including cautions) _________________________________________________________________________________
I can confirm that to the best of my knowledge the information I have given in correct. I accept that providing deliberately false information could result in my dismissal Signature _____________________ Date_____________ Print Name ____________________________ PLEASE RETURN COMPLETED APPLICATION FORM TO: LITTLUNS CHILDCARE 13 SEEND CLEEVE MELKSHAM WILTSHIRE SN12 6PS Many thanks
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