Client Application Form - initial details

Personal Details

	Title:	Mr Miss Mrs Ms Dr Prof
	First Names:		Surname:
	Address:
	Postcode:
	Length of stay at current address:	years and months
	Preferred telephone number:
	Email Address:
	Nationality:
	Do you speak any foreign languages?	Yes No
	If yes, please specify:
	Does anyone in your household smoke?	Yes No
	Would you accept smokers?	Yes No
	Please specify the services and expected duties required:
	Is the babysitting club of interest?:	Yes No
	Placement Preferences
	Earliest start date?		Salary offered:
	Preferred location:
	Date and time services required:
	How many children do you have?	1 2 3 4 5 Over 5 children
	Please provide other relevant information:
	How did you hear about us?

I give permission for Sitting Smart to proceed further