Nanny Application Personal Information *(denotes required field) First Name: * Last Name: * E-Mail Address: * Age Date of Birth Marital Status: Single Married How did you hear about us: Address 1: Address 2: City: State: Zip Code: Daytime Phone: Evening Phone Can you legally accept employment in the US?: Yes No What are your closet major crossroads? When are you available to start? Do you have a Valid Drivers License?: Yes No Do you have a car?: Yes No Has your license ever been suspended?: Yes No Education Have you graduated High School?: Yes No Have you graduated college?: Yes No About Yourself Have you ever been convicted of a misdemeanor including DUI or a felony?: Yes No Do you smoke?: Yes No Do you swim?: Yes No Are you CPR Certified?: Yes No Are you First Aide Certified?: Yes No What languages do you speak? Are you an US citizen?: Yes No Do you have any allergies/health problems that may affect your work?: Yes No Please describe your personality What are your hobbies and interests? Do you have children?: Yes No Are you currently pregnant?: Yes No What type of work are you looking for? (Please note that placement is for 1 year or more unless it it temporary work): Occasional Permanent Part-Time Full-Time Will you be able to work for at least 1 year? Would you prefer a live-in or live-out job?: live-in live-out What are your long term goals? How long do you see yourself working as a nanny? How far are you willing to drive for your job? How many hours a week are you looking to work? What days and hours are you available to work? What are you hoping to earn? Are you willing to do light housekeeping?: Yes No Have you worked as a babysitter before?: Yes No If yes please describe length of time, age of kids, hours/week. Have you worked in a Daycare or school before?: Yes No If yes please describe length of time, age of kids, hours/week. Have you worked as a nanny before?: Yes No If yes please describe length of time, age of kids, hours/week. Would you be interested in a Nanny Share?: Yes No Childcare Experience and references: Other Experience (non-childcare): Additional Personal or Character. Please do not duplicate names from your work experience here. Describe any experience you have with children under 1 year old Describe any experience you have with children ages 1 and 2 years Describe any experience you have with children ages 3 and 4 years Describe any experience you have with children ages 5 years and older Do you have any experience with multiples?: Yes No Please describe: How would you handle a crying baby? How would you handle a temper tantrum in a public place? Have you ever potty trained a child? If yes, Please describe how: Would you be comfortable in potty training a child?: Yes No Please list some activities that you would enjoy doing with a child? Please describe your best childcare experience? Please describe your worst childcare experience? How would you go about disciplining a child? How would you describe your personality? Would you like to bring a child of your own with you?: Yes No Please tell the families why they should hire you! (Note this will be sent out to families) If there is anything that you would like to add that wasn't covered please list that here. CAPTCHA Code: *
