Surname: / First Name:

Application for Registration –Housekeeper or Cook

Thank you for your interest in registering with Centenary Nannies and Babysitters. Please complete the following application form, ensuring that ALL fields are completed. Your personal details, history and preferences will be recorded in our database. Providing complete information will give you the best opportunity to be selected for work with our clients. We hope to welcome you aboard our happy crew of housekeepers and cooks!

Personal Details (Top Section)
Full name
(Company)
Home address
(Physical address only - no PO Boxes please) / Street ______
Suburb ______Post Code: ______
Contact Type /  Housekeeper  Cook
Sex /  Female  Male
Contact numbers
(add to contact view also) / (M) / (H)
(W) / (FAX)
Email
Receive regular updates from us when you provide your email address
(Contact view) / Please print clearly:
______
 I do not have access to email
Type of work required
(Please select multiple categories if applicable)
(Top - Worker Code) /
  • Full Time
  • Part Time
  • Casual
/ FT
PT
CS
Previous Work History (N Tab 1)
Have you had any experience in the cleaning industry?
Please include brief details of years worked and in what organisations/companies – we will refer to your resume work history for further information.
Yes No   / Cleaning for family and friends FF
Yes No   / Agencies AG(please provide brief details of years worked /agencies)
Dates / Agency Name
Yes No   / Private CleaningPC (please provide brief details of years and for whom the work was done)
Dates / Private Work
Yes No   / Other relevant work history OT (please provide brief details of years worked and where)
Dates / Other employment
Your Preferences
Please complete ALL questions to help us match you as closely as possible with prospective clients
What duties have you doneBEFORE:
 Washing
 Ironing
 Bathrooms/Toilets
 Tidy/Clean Kitchen area
 Shopping for family
 Running errands
Cooking/meal preparation
Payment of Bills for family
Caring for animals / Office Use: ()
Wash
Iron
BR
Kit
Shop
Ernd
Cook
Bill
Amls
What dutiesare you willing todo?
 Washing
 Ironing
 Bathrooms/Toilets
 Tidy/Clean Kitchen area
 Shopping for family
 Running errands
 Cooking/meal preparation
Payment of Bills for family
Caring for animals / Wash
Iron
BR
Kit
Shop
Ernd
Cook
Bill
Amls
What hours and days are you prepared to work? (N Tab 3 – Cleaner Pref Hrs)
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Other comments/preferences
How would you describe your ability to cook
 below average average good excellent
Is there any food you refuse to cook? If so, please explain
______
Medical conditions
(N Tab 3:Medcon) / Do you have any medical conditions which our agency or clients should know about?
 No
 Yes (please provide all necessary information)
Suchconditions maybe back problems, knee problems, allergies especially to certain chemicals, asthma etc.
How did you hear about Centenary Nannies?
(N Tab 3:Source) / Our website
Gumtree
Internet research Yellow pages  Newspaper Advert
 Referral (Name & Ph ______)
 Other
Client Safety Prerequisites (N Tab 2)
Applicants please note that a current Police Check is mandatory to be eligible for placement with our clients. Please ask us for further information.
First Aid Certification
(mandatory) /  None  Expired  Yes (provide details below)
Date obtained: / / Expires: / /
Training organisation: ______
Comments:
Police Check or Blue Card(mandatory) / Number: / Date Obtained/exp date: / /
date of birth
(N Tab 1) / (Date, month and year) / Age
General Information (N Tab 2)
Mobility
(N Tab 2) / Do you have a current driver’s licence?
 No – I rely on public transport
 Yes
Licence No. ______
Expiry Date: / /
Type:  Auto and manual  Auto only
Do you have your own car?  Yes  No
Vehicle Registration No. ______
Public Liability/Insurance / Do you have your own Insurance/Public Locality?
Yes
No
What is your policy number? ______
What is the expiry date? ______
Do you agree/acknowledge that Centenary Nannies has informed you about insurance and recommended NannySure?
Yes
No
Are you a smoker?
(Mandatory)
(N Tab 2) /  Yes  No
Marital status
(Optional)
(N Tab 2) /  Married/Defacto
 Single
 Other
Date of Application
(N Tab 2)
Available From
(N Tab 2) / From what date are you available for the above time frames?
______/______/16
How many references are you supplying?
Next of Kin
(N Tab 3) / Name
Relationship to you
Phone contact(s)
Address
Interviewed by
(N Tab 3) /  Rachel  Hayley
How far are you willing to travel to assignments/work? (N Tab 3 – Travel Time Pref.)
 Up to 30 mins from my residence
Greater Brisbane – up to 1 hour each way
As far as required
Work References
We prefer you to have at least 3 verbal referees. Preferably work referees. Please do not supply names of family or friends as these are not sufficient.
Please complete this section fully – do not write “Refer to resume”
FAMILY MEMBERS ARE NOT A REFEREE
N Tab 2: # Refs Supplied
Can you provide us with references from previous employers?
Yes – written references are included with resume and noted below
Yes – phone numbers for verbal references are listed below
No verbal or written references are available at this time
Reference 1:
Name
How do you know this person?
Address
Phone
How long have you known this person?
Reference 2:
Name
How do you know this person?
Address
Phone
How long have you known this person?
Reference 3:
Name
How do you know this person?
Address
Phone
How long have you known this person?
Applicant’s Declaration
I, ______hereby declare all information on this application form is true and correct. I understand that any misleading information may be harmful to my employer’s children, for which I will be held fully accountable. I acknowledge that Centenary Nannies and Babysitters takes no responsibility for any harm to my employer or myself.
Signed: ______Date: ______

Please list some meals that you would enjoy cooking for a family

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Is there a particular style of cooking that you specialise in? ______

Would you be willing to cook meals that the family have request? ______

Do you have any allergies to food? ______

Are there any foods you refuse to cook? ______

Applicant Check List

Please take a moment to review your application to ensure ALL questions have been answered, to give you the best opportunity to be chosen for work with our clients.

We require the following to accompany your application:

Resume

References (if not included in resume)

Copies of Certificates Attained

Copy of Police Check (mandatory)

Copy of First Aid Certificate (if applicable)

Copy of driver’s licence (mandatory if you have one)

Provide us with a photograph of yourself

Please note our guarantee that we will never send your photograph to any other person or organisation without your permission. We store your photograph with your resume and other documents to help us “put a face to the name”.

Sign and date the application

OFFICE USE ONLY

Placement Information
Interviewed by
Hired by Client
Commencement
Conclusion
Rate
Fees paid / Amount: / Method: / Tax Inv # / Receipt #
Payment Register Updated /  Yes
Database entries
completed
Processing check list fully completed
Comments
(Record in Gen Info Tab if applicable)