template

Vacancy Registration Form

Any information provided will be used in the strictest confidence and only for the purpose of searching
for a PA / Carer for you. SNAP16+ is registered with and complies to the Data Protection Act 1998.
Your details will never be passed onto a third party, except with your explicit permission

If you would prefer to have a form posted to you, please click here

If you would prefer to print your own form, please click here

Client Details:

Title

First Name

Surname

Address:

Address 1	Address 2

Town/City

County:
London

Other, Please state

Postcode

Country
UK

Other, Please state

Nearest tube/train station

Nationality:

British

Other, Please state

Religion (If Practicing):

Telephone / Email:

Telephone (Evening)

Email : Please put your e-mail address -
we will not automatically receive it with the form!

Case Manager / Parent / Guardian (if completing on behalf of the client):

Title

First Name

Surname

Telephone / Email:

Telephone (Evening)

Email : Please put your e-mail address -
we will not automatically receive it with the form!

Relationship to client:

Contact details for any other significant people involved in the client's care (e.g. solicitor, parent, guardian):

Start Date?:

ASAP

Date

Are you looking for a:

PA (Personal Assistant)

Care Worker

Buddy / Enabler

Other (Please state)

Will the PA/Carer be:

Daily

Live-in

Either

If live-in, please
give accommodation
details:

Own room

Own room & Bathroom

Separate accommodation

Own room share bathroom with the children

Other accommodation details

Is the position:

Full time

or Part time

Permanent

or Temporary

If Temporary dates from

Any additional details regarding dates

Hours of work:

From

a.m. to

p.m.

Other

Days of work:

Monday to Friday

Monday to Friday + occasional weekends

Other

Personality wise,
what would your ideal
PA /Carer be like?:

Is the position
sole charge? :

Yes

Sometimes

Mostly

(Please put a figure down - it is impossible for us to find someone without a wage!)

Wage / Salary:

Net

(after tax) or gross

(before tax)

Per: Hour

Week

Month

Year

Current Minimum
Market Rates:

Daily gross per hour: £13.00
Daily (Out of London) £11.00 gross per hour
Live-in (London) £10.00 gross per hour
Live-in (Out of London) £9.00 gross per hour

Weekend rates - add two pounds to gross figure
Abroad positions - add two+ pounds to gross figure

Please note: as a specialist agency, we cannot accept wages which are
below the current market rate (except if the position offers additional perks
such as self-contained accommodation etc.). The figures are based on the
annual survey carried out by Nannytax.

Do you need a driver?:

Essential

Preferable

Not necessary

Will the PA/Carer
have use of a car?:

No, will need own car		N/A

Yes, but on duty only		For personal use too

Annual Paid Holidays:

20 days		Other, please state
(statutory, pro rata for part-time)

Is a non-smoker:

Essential

Preferable

Not necessary

Will you take the PA/Carer
on family holidays?:

Yes

Possibly

Any perks/benefits:

Is the PA / Carer expected
to work at weekends?:

Yes

If yes please give details:

Do you have any pets?

Yes

If yes please give details:

Is a male PA/Carer
suitable/appropriate
for this position?

Yes

Preferable

Essential

Would you describe
your household as:

Formal

Informal

Please describe
a typical
days routine/duties
required by
the PA/Carer:

Does the position involve personal care?

Yes

If yes please give details:

Does the position involve using hoists?:

Yes

If yes please give details:

Do you / does the client have any medical needs?

Yes

If yes please give details:

Do you / does the client have any behavioural management requirements?:

Yes

If yes please give details:

How do you / the client communicate?:

Is it essential (rather than preferable) for the PA/Carer to have any specific
experience?:

Please describe your / the client's additional needs:

Are there any specific
activities you
your client enjoy:

Any additional information that you think would be helpful that doesn't fit into the above categories.

If you are planning to go away for holidays etc., please state dates:

How did you
hear about
SNAP16+?:

By submitting this form, I confirm I have read and agree to abide by the terms and conditions of
SNAP16+ (a division of SNAP Childcare Limited). I understand that the introductory fee is 12% of the employees
gross annual wage / or £90 per week for temporary placements. All fees subject to VAT.

Name :

Date:

Name of person responsible for paying placement fees, if different from above:
I confirm I have read and agree to abide by the terms and conditions of SNAP16+ a division of SNAP Childcare Limited)

Name :

Date:

Please answer the following question to prove that you are a real person

What is the sum of two plus two?

*(Excluding USA/Scotland due to specific visa / legislation restrictions)