Babysitting (evenings and weekends)

Babysitting (weekends only)

Temporary nanny jobs (this is normally daytime)

Temporary nanny jobs until permanently placed (this is the day shift)

Post Natal Helper – a.k.a. Baby Nurse work (requires 4 years minimum INFANT experience, some book knowledge helpful)

Night nanny work (requires 3 years minimum INFANT experience)

Part time nanny job (requires 1 year commitment)

Full time nanny job (requires 1 year commitment)

Personal Contact Information

Name (first & last)

Maiden Name

Cell Phone

Major Cross Streets

How Far Will You Drive

Address

City

State

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip Code

Work Phone

Home Phone

Age

Date of Birth (mm/dd/yyyy)

Legal to Work in U.S.

Yes   No

Do you smoke?

Yes   No

If yes, how much?

Have you ever had children?

Yes   No

Are you pregnant?

Yes   No

How old are your children?

Do you need to bring your children with you?

Yes   No

Do you speak any other language other than English? List

Your E-mail

Repeat Email

Placement Preference

Available Starting Date

Requested Salary RANGE Per Hour (Please give minimum): example: $10 - $xx:

Weekly Salary RANGE (Please give minimum) example: $100 - $200:

Position Desired

Choose an Option Nanny - Live In Nanny - Live Out Either Other

Can you give a one year commitment?

Yes   No

Permanent position

Yes   No

Are you interested in babysitting

Yes   No

Do you want summer work only

Yes   No

Available hours

Choose an Option Flexible Days Evenings Other

Are there any times you are UNAVAILABLE? (School, second job, etc.?)

Are you available on weekends?

Choose an Option Yes No Occasional

Are you willing to stay the night?

Choose an Option Yes No Occasional

Will you work in a home where there is a stay at home parent?

Yes    No    Will Discuss   

Are you willing to work in homes with animals?

Yes   No

If no, Explain

Are you interested in baby nurse / night nanny work?

Yes   No

Driving Information

Do you drive?

Yes   No

Year/Make

Driver's License Number

State of license

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Do you have any points against you on your driving record?

Yes   No

If yes, please explain

Are your tags, registration and insurance current?

Yes   No

Criminal Record

Have you ever been convicted of any crime?

Yes   No

If yes, please explain

Education

High School Name

City/State

Years attended

Did you graduate?

Yes   No

Year

List Any Extracurricular Activities

Nanny Experience

Have you ever been a nanny before?

Yes   No

If yes, how many times?

Do you have over 5 years child care experience?

Yes   No

Ages of children previously cared for

Ages of children you would like to care for

Do you have experience with

Twins    Triplets    ADD   

Are you interested in Personal Assistant or Housekeeping? Please list.

Work Experience (Non-Child Care)

Employer One

Start Date

Leave Date

Name

City

State

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Phone

Supervisor Name

Position/Duties

Reason For Leaving

Employer Two

Start Date

Leave Date

Name

City

State

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Phone

Supervisor Name

Position/Duties

Reason For Leaving

Employer Three

Start Date

Leave Date

Name

City

State

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Phone

Supervisor Name

Position/Duties

Reason For Leaving

Personal References

Reference One

Name

Relationship

Years Known

Work Phone

Home Phone

Reference Two

Name

Relationship

Years Known

Work Phone

Home Phone

Childcare References

Reference One

Name

Phone

Ages of Children

Describe Your Job Duties in Detail

Dates Employed

Reason For Leaving

Reference Two

Name

Phone

Ages of Children

Describe Your Job Duties in Detail

Dates Employed

Reason For Leaving

Reference Three

Name

Phone

Ages of Children

Describe Your Job Duties in Detail

Dates Employed

Reason For Leaving

Reference Four

Name

Phone

Ages of Children

Describe Your Job Duties in Detail

Dates Employed

Reason For Leaving

I certify that all of the information included in this application is accurate to the best of my knowledge. I understand that knowingly withholding information or providing false information is grounds for immediate dismissal from employment.

Please click the "Submit Application" button to submit this information. You MUST complete the application before setting up your interview. Please click only once.