Littluns Childcare ©
13 Seend Cleeve, Melksham, Wiltshire, SN12 6PS
APPLICATION FORM
Please fill in in BLOCK CAPITALS in blue or black ink
Position Applied For:
PERSONAL INFORMATION
Surname
First Names
Date Of
Birth
Address
Postcode
Home Tel
Mobile
Email
EDUCATION
University/College
Address
Dates Attended
Subjects & Grades
Achieved
Secondary School
Address
Dates Attended
Subjects & Grades
Achieved
EMPLOYMENT HISTORY
(Continue on a separate sheet if necessary)
1. Employers Address Position Held Salary Reason for
Leaving
Responsibilities
Dates Employed From: To:
2. Employers Address Position Held Salary Reason for
leaving
Responsibilities
Dates Employed From: To:
3. Employers Address Position Held Salary Reason for
leaving
Responsibilities
Dates Employed From: To:
PERSONAL STATEMENT
Please write a short statement about yourself.
Please include the following
• Hobbies and interests
• Reasons for applying
• Your goals and targets for the next year
• Where you see yourself in 10 years time
This is your chance to really sell yourself and set yourself apart from other applicants
so really go for it.
The more we find out about you and your personality the better J Continue on a
separate sheet if necessary.
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References
Employers Position
Name
Address Contact
Telephone
Number
Postcode Reason For
Leaving
May we Yes No If no please
contact your give a
employer reason why
prior to
interview?
Employers Position
Name
Address Contact
Telephone
Number
Postcode Reason For
Leaving
May we Yes No If no please
contact your give a
employer reason why
prior to
interview?
Employers Position
Name
Address Contact
Telephone
Number
Postcode Reason For
Leaving
May we Yes No If no please
contact your give a
employer reason why
prior to
interview?
Supporting Information
Which animals are you happy for your family to have?
Cat Dog Rabbit Small Other
animal
(Hamsters
etc)
Yes No Yes Yes Yes Yes No
No No No
Which of the following would you be happy to do?
Children’s Yes Tidy Children’s Yes No
Cooking No Rooms
Family Cooking Yes Food Shopping Yes No
No
Walk dog/s Yes School/Nursery Yes No
No Runs
Children’s Yes Activity Runs Yes No
Washing No (Ballet etc)
Family Washing Yes Out Of House Yes No
No Babysitting
Washing Up Yes Host Play Dates Yes No
No
Do you/have you suffer from any of the following?
(Please note the answers to these questions will NOT affect your application, families
just prefer to
in advance)
Asthma Yes No Skin Condition Yes No
Epilepsy Yes No Memory Loss Yes No
Fainting Attacks Yes No Other (Please state)
Heart Condition Yes No
If you have answered yes to any of the above questions and the condition is current
please can you tell
us below what medication you are on….
_________________________________________________________________
Do you….
Smoke Yes No
Drink Yes No
If Yes how may units per week on average
1-10 11-20 More than 20
If you aren’t applying for a specific vacancy or in if you are not successful in your
application for a
specific vacancy then it helps us to know exactly what you are looking for and what
your experiences are.
REQUIREMENTS
What type of work are you looking Nanny Babysitter Mothers Help
for? Au Pair Other
What hours are you looking for? Full Time Part Time
Term Time Only
Where are you looking to work? Within a 5 mile radius of my postcode
Within a 10 mile radius of my postcode
Within a 15 mile radius of my postcode
Within a 20 mile radius of my postcode
Anywhere in Wiltshire
Do you wish to…. Live in Live Out Either
What is your preferred age range? Newborn Baby Toddler Child
Young Adult Any
How many years experience do Less than 1 1-2 Years 2-3Years
you have in childcare? 3-5 Years More than 5 years
How many children are you willing 1 2 3 4 More Than 4
to look after at any one time?
What is your preferred method of Sole Charge Shared Care Either
care?
You may have already answered these questions on our previous pages but please
answer the
questions below
Do you have or have you ever had any of the following?
Full UK driving licence? Yes No Is it clean? Yes No
Your own vehicle? Yes No
An enhanced CRB? Yes No
A standard CRB? Yes No
Any criminal convictions? Yes No If yes please give details below
First aid certificate? Yes No Is it current? Yes No
Food Hygiene certificate? Yes No Is it current Yes No
Details of any driving convictions with dates
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Details of any criminal convictions with dates (Including cautions)
_________________________________________________________________________________
I can confirm that to the best of my knowledge the information I have given in
correct. I accept that
providing deliberately false information could result in my dismissal
Signature _____________________ Date_____________
Print Name ____________________________
PLEASE RETURN COMPLETED APPLICATION FORM TO:
LITTLUNS CHILDCARE
13 SEEND CLEEVE
MELKSHAM
WILTSHIRE
SN12 6PS
Many thanks
