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Nanny Application
Click here to print a hard copy of the Nanny Application.

Name:
Address:    
City: State, Zip: ,
Daytime Phone: Evening Phone:
Email: (leave blank if None)
Date of Birth: (e.g. mm/dd/yyyy)
Are you a U.S. Citizen?
Yes  |  No
If not, can your provide us with a current Green Card?
Yes  |  No
Driver License #    
Do you own car?
Yes  |  No
Do you currently have car insurance coverage?
Yes  |  No
Have you ever had a moving violation or been in a car accident?
Yes  |  No
If so, please list the dates and the circumstance:
Have you ever been convicted of a felony?
Yes  |  No
If so, please explain:
Do you smoke?
Yes  |  No
Are you CPR and First Aid certified?
Yes  |  No
Do you know how to swim?
Yes  |  No
Do you have any medical conditions, lifting restrictions or allergies?
Yes  |  No
If so, please explain your conditions:
Do you currently have health insurance?
Yes  |  No
Please provide us with an emergency contact for yourself
Name:
Phone:
Relationship:
 
Highest Level of Education completed:
Name:
State attended:
Did you graduate?
Yes  |  No
Name:
State attended:
Major:
Did you graduate?
Yes  |  No
Other than English, what other languages are you fluent in?
Please list any additional trainings, certificates or classes that are relevant to childcare:
 
(please list 3 most recent childcare related experience/employment)
Name of Employer:
Phone Number:
Start Date: (e.g. mm/dd/yyyy)  
End Date: (e.g. mm/dd/yyyy)  
Age(s) of children:
Direct Supervisor:
Daily Job Responsibilities:
Reason why employment ended:

Name of Employer:
Phone Number:
Start Date: (e.g. mm/dd/yyyy)  
End Date: (e.g. mm/dd/yyyy)  
Age(s) of children:
Direct Supervisor:
Daily Job Responsibilities:
Reason why employment ended:

Name of Employer:
Phone Number:
Start Date: (e.g. mm/dd/yyyy)  
End Date: (e.g. mm/dd/yyyy)  
Age(s) of children:
Direct Supervisor:
Daily Job Responsibilities:
Reason why employment ended:
 
Applying for:

Part Time (under 25 hours)

Full Time (25-40+)

Occasional Sitting

Travel Only
Hourly salary desired:
Any other benefits or privilege expectations you have?
What age group of children do you feel most comfortable caring for?
What is the maximum amount of children you will car for?
Have you ever worked with children with special needs?  If so, please explain:
Are you open to working with children with special needs?
Yes  |  No
Are you open to participating in play dates or other group activities/programs?
Yes  |  No
Do you have any issues or allergies to family pets?  If so, please explain:
Please check any additional household chores you are open to doing:

Dinner Preparation

Child's laundry

Pet Care

Driving children to/from scheduled activities

Running errands

Light house keeping

Cleaning up after children
 
(provide two (2) references that are not relatives)
 
Name:
Phone Number:
Years known:
Relationship:

Name:
Phone Number:
Years known:
Relationship:

Tell us why you want to be a nanny:
What discipline strategies have you found to be most effective when working with young children?
What are some daily activities you would do with an infant (child under 15 months)?
What are some daily activities you would do with a young child (15 months +)?
What are your expectations of the family?
What are your hobbies and interests?
Are you willing to make a one (1) year commitment to a family?
What are your future goals?
How did you hear about our agency?
 
I certify that the information on this form is correct to best of my knowledge
I give Neighborhood Nannies permission to do a criminal background check