Maternity Nurses

Please fill in the form below. To submit a completed registration you will be required to complete your 5 year career history on page two of this form. Any necessary amendments can be made during your registration interview.

* indicate the required fields

Personal Details

Title
First Name
Last Name
Address 1
Address 2
Town
County
Postcode
Phone Number
Mobile
Email
D.O.B
Nationality
Marital Status
Is the candidate permitted to work in the U.K? Yes No

Education, Experience & Qualifications

Norland
Princess Christian
Chiltern

ADCE
NNEB
NVQ2

NVQ3
Cache2
Cache3

BTEC
NAMCW
MNT

Other

Number of years experience as a Maternity Nurse
Number of years experience as a Nanny
Please give details of courses completed to complement your Maternity skills
Current Enhanced Disclosure issue date
(if held - dd/mm/yyyy)
Paediatric First Aid Certificate expiry date
(if held - dd/mm/yyyy)
Does the candidate have a driving licence? Yes No
Does the candidate have their own car? Yes No
Have you cared for twins before? Yes No
Have you cared for triplets before? Yes No
Have you cared for premature babies? Yes No
Have you worked with babies with medical conditions? If so, please give details

Position Required

Type of work sought

Nanny Maternity Nurse Night Nanny

UK Positions
UK Rate
Overseas Position
Overseas Rate
Please add details on the type of role you are looking for
Would you be prepared to occasionally help out with light house work? Yes No

About You

How would you describe yourself and your areas of expertise?

Strict Routine
Relaxed Routine
Breastfeeding Expert

Sleep Training Expert
Excellent Medical Background
Good All Rounder

Very Experienced
Would Benefit From More Experience
Newly Qualified

Experience With Overseas Families
Prefer UK

Do they speak any foreign languages? Yes No
If yes, please state
Do they have any allergies? Yes No
If yes, please state
Do you have any hobbies, skills or special talents relevant to the profession?
Are you a vegetarian? Yes No
If yes, would you prepare meat? Yes No
Do you smoke? Yes No
If yes, would you be prepared to not smoke on duty? Yes No

Health Check

Has the candidate had any physical problems requiring specialist referral in the past 5 years? Yes No
If yes, please state
Do they have, or has suffered from, any mental problems in the last 5 years? Yes No
If yes, please state
Has the candidate at any time, suffered from any physical or mental health problems that could affect their ability to work as a nanny with sole charge of young children? Yes No
If yes, please state
Is the candidate taking any regular prescribed medicines? Yes No
If yes, please state Does the candiate consent to Tigerlily Childcare contacting their GP for further information and to contacting an occupational health physician (if reguired) in connection with the above? Yes No

Criminal Check

Does the candidate have a prosecution pending or have they ever been convicted at a court or cautioned by the police for any offence? Yes No
If yes, please provide details of pending prosecutions, convictions and bind-over orders including the approximate date, the offence and the court or police force that dealt with the offence:

Declaration

Has the candidate certified that the information given on this application form is true and correct and gives permission for Tigerlily Childcare to verify any references supplied. Do they also agree to treat all information given to them regarding vacant positions as confidential and agree not to pass any names or addresses of potential employers to any other person?

Agreed Yes No