Required fields are indicated with an asterisk (*), but please fill
out the application as completely as you can.
CONTACT INFORMATION
First Name:*
Last Name:*
Have you ever used another name? If so:
Street Address:
City:
State:
Zip Code:
General Location:
Home Phone:*
Cell Phone:
Email:*
PERSONAL INFORMATION
Are you legally able to work in the US?
--None--
Yes
No
Have you ever been convicted of a felony?
--None--
Yes
No
Please do not include any information about any
arrest or detention that did not result in a conviction; any conviction where your
record has been expunged, sealed or eradicated; any misdemeanor conviction where you
have completed probation and the case has been dismissed; or any arrest where you have
successfully completed a pretrial diversion program.
*The existence of a criminal record is not an absolute bar to referrals, placements or employment.*
Driver's License #:
Do you have access to a car? (yes/no)
Do you like pets?
Do not like pets
Like Dogs
Like Cats
Like Dogs and Cats
Like all pets
For help selecting multiple answers,
click here .
Can you swim?
--None-- Yes
No
A little
Do you smoke?
--None--
Yes
No
Are you comfortable with a parent at home?
--None-- Yes
No
Job Preferences:
Live In
Full Time
Part Time
After School
Summer
Temporary
Evenings/Weekends (occasional)
Travel (occasional)
For help selecting multiple answers,
click here .
Check all duties you'd be willing to perform:
Prepare Meals - Family
Prepare Meals - Child
Laundry - Family
Laundry - Child
Ironing
Clean Bathroom
Grocery Shopping
Care for Elderly
Care for Pets
Errands
House Sit
Light Vacuum & Dusting
Keep Kitchen Straightened
Tidy Child(ren)'s Room
Help with Homework
Carpools
Driving to Activities
For help selecting multiple answers,
click here .
Ideal schedule:
Available start date: (mo/day/yr)
Class Schedule (if applicable):
Do you anticipate any schedule changes?
Requested Compensation
(pre-tax, hourly or weekly):
EDUCATION
1. Name Of High School:
Location: (city/state)
Did you graduate?
--None-- Yes
No
2. Name Of College/Other:
Location: (city/state)
Degree/Major:
Did you graduate?
--None-- Yes
No
Describe any additional training:
CHILD CARE EXPERIENCE
Please list ALL childcare experiences: long-term babysitting, volunteering, internships,
teaching, etc.
1. Name of Family/Company
Location:
Dates Employed: (mo/yr-mo/yr)
Ages Of Children:
Position:
Type Of Position:
--None-- Full Time
Part Time
Occasional/As Needed
Daytime Phone Number:
Reason For Leaving:
2. Name of Family/Company
Location:
Dates Employed: (mo/yr-mo/yr)
Ages Of Children:
Position:
Type Of Position:
--None-- Full Time
Part Time
Occasional/As Needed
Daytime Phone Number:
Reason For Leaving:
3. Name of Family/Company
Location:
Dates Employed: (mo/yr-mo/yr)
Ages Of Children:
Position:
Type Of Position:
--None-- Full Time
Part Time
Occasional/As Needed
Daytime Phone Number:
Reason For Leaving:
Select the types of experience you've had:
Newborn Care (Under 3 months)
Infant Care (3-12 months)
Toddler Care
School-Aged Children (Pre-K and Up)
Special Needs Children
Elderly Care
Housekeeping
For help selecting multiple answers,
click here .
NON-CHILD CARE WORK AND VOLUNTEER HISTORY
Please list any non-childcare paid or un-paid positions held.
1. Company or Volunteer Organization Name
Dates Employed: (mo/yr-mo/yr)
Supervisor's Name:
Position:
Daytime Phone Number:
Reason For Leaving:
2. Company or Volunteer Organization Name
Dates Employed: (mo/yr-mo/yr)
Supervisor's Name:
Position:
Daytime Phone Number:
Reason For Leaving:
QUESTIONS
1. Why do you want to be a nanny?
2. What activities do you enjoy doing with children?
3. What are your hobbies and interests?
4. How would people who know you describe your personality?
5. How long would you consider staying with the family?
6. Describe your philosophy of discipline.
7. List 3 precautions to keep a child safe:
How did you hear about us?:
Internet Search
Yellow Pages
A friend
Newspaper
Another agency
Other
For help selecting multiple answers,
click here .
Are you working with other agencies? If so, which?
Please review and check the following box, then print out and retain a copy of this application,
agreement and The Nanny Network's Terms of Use for your records before submitting your application:
By clicking "I agree" below, I hereby certify, represent and warrant that I
have carefully read and agree to all the terms and conditions stated above and in
The Nanny Network's Terms of Use , and that I fully understand their final and binding effect.
I agree *