Childcare, Early Education or Playwork Careers

Childminding preliminary application form

The government aims to increase the number of child carers from under represented groups in the community.

The information you give us on this form will be used for monitoring only and will help us to monitor and improve the service we are able to provide to people interested in becoming a child carer.

Please make sure you fill in the fields marked with *

Title:*

First name:*

Last name:*

Door Number and Street:*

City / Town:*

County:*

Postcode:*

Telephone:

Email:*

Date of Birth:* (i.e. 01/01/1970)

Gender:*

Do you consider yourself to have a disability?*

Ethnicity:*

If other, please specify:

Note:

If you live in a Local Sure Start area (Abbey, Gascoigne, Marks Gate or Thames) we may forward your details onto the Sure Start Worker for your area. They will be able to give you additional support with your application to become a childminder.

I give permission for my details to be passed on to the Sure Start Worker.*