Looking for a Housekeeper / Carer?
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Housekeeper / Carer Application / Registration
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Mrs.
Miss
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Fr.
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Last Name
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Address Details
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Address 2
City
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Contact number in case of emergency
Email
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Kuwait
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USSR
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Vatican City State
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West Bank and Gaza
Western Sahara
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Yugoslavia
Zaire
Zambia
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Personal Details
Nationality
Religion
Do you practice it? Yes or No
Family, Home & Education
Mother's Occupation
Father's Occupation
Number and ages of brothers and sisters
Name and address of school and/or university
Any additional qualifications
How long have you studied English?
What is your knowledge of English?
Please Select
Fluent
Good
Fair
Poor
Other languages: (please specify)
Employment & Experience
Current Employment
Previous Employment
Relevant experience. Please describe fully your relevant experience
Have you lived abroad before?
Yes
No
Do you have experience of the following household duties?
Please Select
Laundry
Ironing
Cooking
Shopping
Would you accept: A single parent family(male)?
Yes
No
A single parent family(female)
Yes
No
A family with no children?
Yes
No
Do you have a driving license?
Yes
No
Are you happy to drive in the UK?
Yes
No
Please list any driving convictions
Do you have a criminal record (if so, please give details)
Other Details & when you are Available
Are you in good health physically?
Yes
No
Are you in good health mentally?
Yes
No
Are you a vegetarian?
Yes
No
Do you smoke?
Yes
No
If yes, are you prepared to smoke outside only?
Yes
No
Are you comfortable with Pets?
Yes
No
When are you available from
For how long?
Return date
Location Preferred
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