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NANNY APPLICATION FORM

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					CC. No: 2007/181269/23

NANNY APPLICATION FORM
Today’s Date Present Address
City: …………………………. Province: ……………………

Name & Surname Permanent Address
City: ……………………….. Province:………………….. ……………………………… ………………………………

E-mail Address Alternative Res Address
………………………. ………………………. ………………………. ……………………….

Cell/Tel Nos: Postal Address
……………………… ……………………… ……………………… ………………………

PERSONAL & FAMILY BACKGROUND
Marital Status No of Dependants: ...………………………… …………………………... Any Dietary Restrictions ……………………………… ……………………………… ……………………………… Guardian Have you ever had a child? Yes……………… No:………………

Single : ………………………. Married: ……………………… Divorced: ……………………. Allergies ………………………………… ………………………………… …………………………………

Yes: ………………… No: …………………. Health Status ……………………….. ……………………….. ………………………..

What are your hobbies and interests? 1………………………………. 2………………………………. 3………………………………. 4………………………………. Kids Favorite Age Group Please mention: ……………………………… ……………………………… ………………………………

Do you any future goals?

Do you speak any foreign language? 1…………………….. 2…………………….. 3…………………….. 4…………………….. Would care for handicapped? Yes: ………………… No: …………………. Have you ever cared for newborns? ……………………. ……………………. …………………….

1…………………………… 2…………………………… 3…………………………… 4…………………………… Maximum Number of Children to care for: …………………………… …………………………… ……………………………

Stenjwa Puleng Trading Enterprise: Managing Members: Richard T Nene; Matsi-Puleng Kheswa P O Box 331, Dube, 1800, Soweto, Gauteng Tel: 011 476-2186 Cell No: 084 579 4979 / 082 585 6902

CC. No: 2007/181269/23

PERSONAL & FAMILY BACKGROUND cont.
Do you swim? Are you a good swimmer? Could you work for a smoker? Would you request for a separate bathroom? Yes: ………………… No: ………………….

Yes: …………………………. No:

Yes:….………………. No: ………………….. State for how long…. ………………………… …………………………

Yes: …………………… No: …………………….. If not, then why ……… …………………………..

INDICATE YOUR INTERESTS: (mark with x)
Music Very much………………… Not too much…………….. Not at all ………………….. Writing Very much …………. Not much …………... Not at all ……………. Computers None ………………. Very much ………… Sewing Very much ………. Have an idea ……. Not at all …………

Movies Very much ………………… Not much …………………. No interest ……………….. Piano Very much …………………. Not much …………………… Not at all …………………….

Sports Very much ……………. No too much …………. Not at all ………………. Art Very much.……………. Not much ……………… Not at all ……………….

TV Very much ……….. Not too much ……. Not at all ………….

Shopping Very much ………….. Not too much ………. Not at all …………….

Stenjwa Puleng Trading Enterprise: Managing Members: Richard T Nene; Matsi-Puleng Kheswa P O Box 331, Dube, 1800, Soweto, Gauteng Tel: 011 476-2186 Cell No: 084 579 4979 / 082 585 6902

CC. No: 2007/181269/23

EDUCATION
Primary School School & Location …………………………… …………………………… …………………………… …………………………… High School School & Location …………………………… …………………………… …………………………… College School & Location …………………………… …………………………… …………………………… Other Subjects ……………………….. ……………………….. ……………………..... Phone Nos ……………………….. ……………………….. ……………………….. ……………………….. Phone Nos ……………………….. ……………………….. ……………………….. Phone Nos ………………………. ………………………. ……………………….

Subjects ……………………… ……………………… ……………………… Subjects ………………………. ………………………. ……………………….

CHILDCARE EXPERIENCE
Have been a Nanny before? Ages of children cared for ……………………………. ……………………………. ……………………………. Physical Address of previous employer ……………………………. ……………………………. ……………………………. Contact details of previous employer ……………………….. ……………………….. ……………………….. Advise what is the right time to call ………………………… ………………………… …………………………

………………………………… ………………………………… ………………………………… Length of employment

………………………………… …………………………………

Stenjwa Puleng Trading Enterprise: Managing Members: Richard T Nene; Matsi-Puleng Kheswa P O Box 331, Dube, 1800, Soweto, Gauteng Tel: 011 476-2186 Cell No: 084 579 4979 / 082 585 6902

CC. No: 2007/181269/23

REFERENCES
Please provide at least two of any references such day care, nursery, baby sitting, camps PLEASE NOTE: No friends or relatives

Name …………………………………. …………………………………. ………………………………….

Relationship ……………………………. ……………………………. …………………………….

Cell No ………………………. ………………………. ……………………….

Home Nos ……………………….. ……………………….. ………………………..

Stenjwa Puleng Trading Enterprise: Managing Members: Richard T Nene; Matsi-Puleng Kheswa P O Box 331, Dube, 1800, Soweto, Gauteng Tel: 011 476-2186 Cell No: 084 579 4979 / 082 585 6902

CC. No: 2007/181269/23

HEALTH INFORMATION
Do you take any medication If yes, please indicate ? Yes……………………………… No.……………………………… …………………………………… …………………………………… Do you smoke? If yes, how many a day Are you under any hospital care ? If yes, please explain Yes.………………………………. No..………………………………. ……………………………………. ……………………………………. If asked could you stop smoking in your family’s home? Yes….…………………………… No…..…………………………… …………………………………… Do you take any alcoholic beverages? Yes……….…………………….. No……………………………... ………………………………….. ………………………………….. If you get permanent employment would you allow the company to take you for: Physical examination: ………. Drug Screening: ……………… HIV Test: ……………………….

Yes …………………………….. No………………………………. ……………………………….

Stenjwa Puleng Trading Enterprise: Managing Members: Richard T Nene; Matsi-Puleng Kheswa P O Box 331, Dube, 1800, Soweto, Gauteng Tel: 011 476-2186 Cell No: 084 579 4979 / 082 585 6902


				
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