Offline:
Please print off and complete the following form in block capitals and return it to Rockinghorse.

Online:
Please complete the following form and press submit button, and email the relevant attachments of certificates to Rockinghorse (nannyform@rockinghorsenannies.com).

Name:

Address:

Father's work tel:
 		Home telephone No.:

Fax:

Mobile:

Email:

Mother's work tel:
Father's Nationality:

Occupation:

Religion:
Mother's Nationality:

Occupation:

Religion:
Children's names, dates of birth, sexes:

Schools/ activities attended:

Domestic staff employed:

Family pets:

Nanny Maternity Nurse
Permanent Temporary
Live-in Daily
Mother's Help Housekeeper
Full-time Part-time
Baby sitter (after 6pm)
Date req. from: . . To (if temp): . .

Non smoker?
Is a car available?
Is a car driver essential?
On duty? Off duty?

Will your nanny be required to take sole charge of the children?
All day Overnight Occasionally
What duties will your member of staff be required to undertake?
(Please note that nannies will not do general household duties not connected with the children in their care.)
Nursery duties Light housework Shopping
Other

Days of work:  
Hours of work: a.m. to: p.m.Evening babysitting:
Annual paid holiday in addition to statutory holidays:
Net salary: Gross salary:

What accommodation will you be able to provide for your live-in nanny?
Own flat/cottage: Own bedroom: Own bathroom:
Shared bedroom: Own sitting room: Own TV:
Please give further details about the type of nanny you require and any useful information about your family e,g, dietary, travel & special needs requirements etc.- the more information the better!
Please use a separate piece of paper if needed.
How did you hear about Rockinghorse?

I hereby certify that the information given in this form is correct that I have read, and agree to abide by, the Terms of Business set out by Rockinghorse.
Signed Date

FOR OFFICE USE ONLYReg No:
Employee Ref no Inv no Inv date Fee