Nanny Application
(Part 1)
PERSONAL INFORMATION -
(
*
) required
*
Name:
Maiden Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Phone:
Cell Phone:
*
Email :
List of all previous address you have lived at:
Date of Birth:
(00/00/00)
Are you legally able to work in the USA? :
Select
Yes
No
Social Security #:
Do you have a current passport?:
Select
Yes
No
Do you have a valid license?:
Select
Yes
No
License #:
State Issued:
Do you have a car?:
Select
Yes
No
Make/Model/Year:
License Plate#:
Insured by:
List all states you have held a drivers license in:
List any moving violations, citations or accidents you may have incurred:
Are you willing to transport children in your car?:
Select
Yes
No
List any foreign languages you speak fluently:
Date available to begin working:
How many hours per week are you looking for?
How long of a commitment are you willing to make ?
What is your availability?
Monday
Friday
Tuesday
Saturday
Wednesday
Sunday
Thursday
Are there any situations that would change your availability?
Select
Yes
No
If so, explain:
Desired Weekly Salary:
EDUCATION
High School:
City/State:
Years Attended:
Date Graduated:
(00/00/00)
College/University:
City/State:
Years Attended:
Date Graduated:
(00/00/00)
Degree/Major:
College/University:
City/State:
Years Attended:
Date Graduated:
(00/00/00)
Degree/Major:
Graduate School:
City/State:
Years Attended:
Date Graduated:
(00/00/00)
Degree/Major:
CHILDCARE EXPERIENCE
(List all childcare experiences. Please do not include relatives)
Name of Family:
Address:
Dates Employed:
Position:
Ages of Children:
(when you began)
Phone Number:
May we Contact them?
Select
Yes
No
Reason for Leaving:
Name of Family:
Address:
Dates Employed:
Position:
Ages of Children:
(when you began)
Phone Number:
May we Contact them?
Select
Yes
No
Reason for Leaving:
Name of Family:
Address:
Dates Employed:
Position:
Ages of Children:
(when you began)
Phone Number:
May we Contact them?
Select
Yes
No
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