STAFF APPLICATION FORM
Please fill in and print the form then send to The Maternity Nurse Company along with your CV and Photograph.

First Name: Surname:
Address:

Marital Status:

Email:

Telephone: Nationality:
Religion: Mobile:
Date of Birth: Age:
Relationship: Next of Kin:
Contact No.: Positions required:
Ideal length of Booking: Preferred Location:
Do you Drive: Do you have multiple Birth Experience:
Other languages spoken: Criminal Convictions:
Valid Passport: Passport No.:
Do you like animals: Do you Smoke:
Are you in good health: If no, details:
Do you have any dietary Requirements: 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)
Please give details of at least two people whom we may contact for a reference:
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.
Signed: Date:
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