Customer Profile Form

Customer Profile Form

Please fill out your personal information and complete your requirements to help us match you to an experienced nanny who will provide loving care for your children. Please be advised that by filling in and submitting this form, you accept and agree to the terms and conditions.
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Age*
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Marital Status*

SingleMarriedDivorcedWidowed
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Occupation*
Tell us about your family?*
Example: We are a family of four, we have two lovely girls aged 5 and 2. We are a happy and joyous family!
Do you have any pets?*

YesNo
Which pets do you have?
Example: We have a dog and fish
Where is the job?*
Number of Bedrooms*
Example: 5
Number of Kitchens*
Example:2
Number of Bathrooms*
Example:2
Number of Lounges*
Example 1
Number of Patios*
Example: 0
Number of Balconies*
Example: 0
Is the job gender specific?*

YesNo
What is the job description?*
Is the job live-in or live-out?*

Live inLive out
Are you aware of any transport problems in your area?*

YesNo
Describe the workers quarters and amenities*
What is the age preference?*
Do you prefer any culture or language group?*
Is appearance important to you?*

YesNo
What happened to your last domestic worker?*
Do you have any requirements outside the remit of domestic duties?*
What monthly salary are you offering?*
Please tick and indicate salary parameters*

Basic SalaryTransport AllowanceFood AllowanceOther
Does this include transport?*

YesNo
If sleep in, does this include food?*

YesNo
Anything else that you would like to tell us about the job*
What skills do you require? Please tick as required*

CleaningFood preparationTable layingChildmindingNewborn baby care/baby careShopping listsLaundryReading to childrenShoppingTidyingBakingDriving
What character traits and abilities are important to you? Please tick as required*

HonestyReliabilityPunctualityLoyaltyConfidentQuietCalmIntrovertOutspokenPassiveOutgoingTraditionalInnovative
What happened to your last domestic worker?*
Do you have any requirements outside the remit of domestic duties?*
What monthly salary are you offering? Please note that we do not do placements under R3000pm*
When do you need the candidate to start?*

MonthDayYear
Date
Date signed*

MonthDayYear
Date
Client Signature*
Witness Signature*
Employee Signature*
Signed at*
Should be Empty: