Gen122 | Client

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- Client Registration Form
							
									Contact Details
													First name *
													
													Surname *
													
													Address *
													
													Post_code *
													
													Daytime Telephone *
													
													Mobile number *
													
													email address *
													
									Family Information
													Mother's Occupation
													
													Father's occupation
													
													What is your nationality ?
													
													What is your religion? *
													
													What languages do you speak?
													
													What is your marital status?
												
													Do you have any Children?
												
													If Yes, please specify number
													
									Family Information cont'd
													Children's Names, Ages & Gender
													
													Do the children attend school or Nursery?
												
													How far is the School or Nursery from your home?
													
													Do any of the children stay home all day?
												
													Do any of the children have special needs?
												
													Any other information regarding the children (Allergies, etc.)
													
													Are you expecting a baby?
												
													Does any family member have a criminal record?
												
									Family Information cont'd
													
													Do you have any pets?
												
													If Yes, please specify
													
													Family hobbies
													
													Do you smoke?
												
													Are there any health and safety issues that we need to know about? *
												
													If yes, what steps have you taken to prevent or control such risks?
													
									More Info
													
													Accomodation type
												
													If a house, please specify type
												
													Number of reception rooms
													
													Number of Bedrooms
													
													Number of bathrooms
													
													Number of floors
													
													Name of the nearest train/tube station
													
													Will the Nanny/Aupair have their own Room? *
												
													Please give a description of the accomodation available for the staff *
													
													Tick facilities available to Aupair
												
									About Staff
													
													Childcare Required
												
													Length of service required *
												
													Age preferred
												
													What nationality do you prefer?
													
													What gender do you prefer?
												
													Are you seeking someone trained/Experienced?
												
													Will the employee have sole charge whilst both parents are at work?
												
													Your need for a staff with driving license
												
									About Staff Cont'd
													
													what is the level of English Sought?
												
													what are the other languages you require?
													
													Happy to do a telephone interview as Some candidates are still abroad? *
												
													What is the total working hours required per week? *
													
													What are the duties to be assigned to the staff? *
													
													Days/Time staff is required to work *
												
													Do you require night Babysitting? *
												
													Your target weekly pay rates *
													
													When do you want service to commence? *
												
By submitting this form, I confirm that the information I have given to Gen122 is accurate and acknowledge that
														I have read carefully and agree to the fee structure and terms of business now and in any future dealings with
														the agency. I also understand that the terms as laid out by Gen122 Limited is a contract governed by English
														Law

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- Client Registration Form

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