Staff Application

First Name:

Surname:

Address:

Marital Status:

Email:

Telephone:

Nationality:

Religion:

Mobile:

Date of Birth:

Age:

Relationship:

Next of Kin:

Contact No.

Positions required:
Daily Nightly Residential (24hrs) Don't Mind

Ideal length of Booking:

Do you Drive:
Yes No

Do you have multiple Birth Experience:
Yes No

Other Languages Spoken:

Criminal Convictions:

Valid Passport:
Yes No

Passport No.

Do you like animals:
Yes No

Do you Smoke:
Yes No

Are you in good health:
Yes No

If no, details:

Do you have any allergies:

What is your weekly booking fee:

What are your hobbies:

Please list all GCSE and A Level Passes:

Please list all Childcare Qualifications:

Please list your past 5 jobs (including address):

Other relevant Qualifications / Experience:

Do you hold a current Enhanced Disclosure through the CRB?
(if yes, please send a copy; if no, please ask us about applying for one)
Yes No

Please give details of at least two people whom we may contact for a reference:

Reference 1:

Reference 2:

NB. Maternity Nurses are not charged for this service. We do our utmost to find suitable placements for our staff, but cannot guarantee that employment will be found.
If any of the above information is misleading or untrue in anyway, The Maternity Nurse Company reserves the right to remove the applicant from our register.

I hereby declare that all the information given on this form is correct and may be used by The Maternity Nurse Company at their discretion. I understand that as a Maternity Nurse I am self-employed and therefore responsible for my own tax and National Insurance payment. I have read and agree to abide by the Terms and Conditions of Business of The Maternity Nurse Company.

Tick if you agree to the above text

You can now upload your CV and Photo to The Maternity Nurse Company in a digital format. The CV should be either a Word File or a PDF Acrobat document. The Photograph should be a jpeg image.

Upload your digital CV:

Upload your photograph: