Pocket Nanny Intake Form
Thank you for choosing Pocket Nanny! We are excited to be on this journey with you.
Disclaimer
Pocket Nanny is a 'Placement Agency'. Our goal is to find you work. However, we do not guarantee that you will be employed but registering with us may improve your chances.
Confidentiality of Information
Pocket Nanny will keep the information you provide in this application strictly confidential. We will only share your information for the purpose of finding you work.
Things you need to complete this form;
Read through the form before you start.
List 2 contact persons who can give you a reference.
Upload a valid ID
Upload First Aid Certificates or any other relevant Certificates- Optional
Upload 2 written References from your 2 listed Referees.
Pay a $15 Placement fee - payable when we find you work.
Let's Begin.
Today's Date
*
Full Name
*
First name and surname.
Age
*
Date of Birth
*
dd/mm/yyyy Example: 08/03/1970
Gender
*
Please Select.
Female
Male
Profile picture - take a closeup picture with your face clearly seen. Your profile will be shared with the client so please keep your picture professional - 'no hand signs'.
*
Current E-mail Address
*
You can use your relative/friend's email if you do not have an email. We will use that email to correspond with you.
Marital status
*
Married
Single
Widow
Do you have children?
Pleass select.
No
Yes - 1 child
Yes - children
Yes - 3
How many children do you have & their ages?
*
Example: 2 children ages 14 & 18 years old. If no children say no children.
Residential Address
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House /Lot Number & Street Name & Area
Town & City
Town (e.g. Nasinu)
City (e.g. Suva)
Postal Address. If none put NA.
Phone Number (s).
*
Please make sure your phone number is correct because we may contact you for work.
Your Emergency Contact- Full Name & Phone Number
*
We will call this person if you are in an emergency situation. Example: Tomasi Waqa- 3394345/ 9564357 / 7350455
Languages you speak? You can select more than 1 option; if you select 'other' you need to write something in the space or an error will pop up.
*
English
Fijian
Hindi
Rotuman
Other
List down your Hobbies, Strengths & Weaknesses
*
List the 3 areas in bullet points. Limit of 4 Lines in total.
What is your Facebook and Instagram Profile Name?
*
List 1 if you don't have both.
What do you currently do?
Maximum 5 lines.
Health details
Do you smoke?
Yes
No
Are you in good Health?
Yes
No
Do you have health issues that we should be aware of? Please specify.
*
Also mention allergies if any.
Availability & Preference
What date can you start work?
*
-
Month
-
Day
Year
Date Picker Icon
What mode of work are you looking for?
*
Full time (8 hours a day)
Part-Time (few hours /few days a week)
Live In
Other
From the list below - what work can you do? You can select more than 1
*
Child Care
Deep Cleaning
Light Cleaning
Laundry
Ironing
Cooking
Caregiving
Grocery Shopping/Marketing
Meal preparation
Other
How soon can you start work?
*
Immediately
Few days time
Other
Qualifications
Do you have a First Aid Certificate or any other relevant Certificates? Please specify.
*
List it down with year of certificate. Maximum 3 lines.
Work Experience & Skills
List down your employment history.
*
Maximum 6 lines.
What age groups have you worked with? You can select more than 1
*
Newborn
Toddlers (1-3 years)
Over 3 years old
Children with disabilities
Adults
Other
What other skills do you have? You can select more than 1. Use 'other' to list other skills you have.
*
Cooking
Baking
Gardening
Music/ Dancing / Singing
Art & Craft (includes weaving)
Traditional protocols
Story Telling
Swimming
Driving
Traditional Massaging
Friendly with pets (e.g. dogs or cats)
Organise the family's Shopping
Other
Pay/Wages
What pay range are you expecting and mode? You can mention your rate per hour as well.
*
Example: $35 -$50 a day or Rate per hour = $6 an hour . Please note - your Wages are negotiable with the client because it depends on work required.
How do you prefer to receive your pay?
Mpaisa
My Cash
Bank Account
Cash
Other
Reference
Please give contacts of 2 people you worked for as a nanny or similar work. Pocket Nanny will contact them for a reference.
Referee 1 - Full Name of contact person
*
Please provide person's name and not the company name.
Referee 1 - Occupation & Employer?
*
Please provide his/her occupation and place of employment
Referee 1 - Phone number (s) or email address or Social Media profile name
*
Please ensure you provide the correct details.
How long did you work for Referee 1 ?
*
Example : 4 years - 2014 to 2018.
List duties you did for Referee1?
*
Summarise in bullet points.Maximum 5 Lines.
Reason employment ended with Referee1?
*
State reason why you no longer working for Referee 1. Maximum 5 lines.
Reference 1 - upload reference letter here
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Referee 2 - Full Name of contact person
Please provide the person's name and not the company name.
Referee 2 - Occupation & Employer?
*
Please provide his/her occupation and place of employment
Referee 2 - Phone number (s) or email address or Social Media profile name
*
Please ensure you provide the correct details.
How long did you work for Referee 2?
*
Example: 6 years - 2010 to 2016.
List duties you did for Referee 2?
*
Summarise in bullet points. Maximum 5 lines.
Reason employment ended with Referee 2?
*
State reason why you no longer working for Referee 2. Maximum 5 lines.
Reference 2 - upload reference letter here
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Drag and drop files here
Choose a file
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Comments
Feel free to write anything that you want the client to know which has not been mentioned earlier.
You can write more than 1 point.
$15 Placement Fee
Please ensure you make payment when you are employed because it allows me to find work for other women, like I did for you. Please choose which payment option you will use to pay.
Mpaisa to - 9423239 $15.00 (Philo Mario)
WBC Bank - A/C 9808063094 $15.00 A/c Name: Philo Mario Narration your 'first & last' name.
Declaration by the Applicant
It is an offense to provide false & misleading information.
Do you declare that the information provided by you is correct and not misleading.
*
Please select.
Yes
No
Do you understand that your registration is not a guarantee that you will be employed?
*
Please select.
Yes
No
Security Details
Have you ever had a criminal record?
Yes
No
Uploads
Valid ID and any relevant certificates.
Upload a Valid ID.
*
Upload Relevant Certificates or anything that supports your experience.
Submit
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