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Applications Nannies | 1. Nanny Application| 2. Interview Form |3. Physician's Report
|4. Information Verification Release | 5. Autobiographical Letter|6. Caregiver Agreement Form| 7. CORI Request Form |
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Applications > 1. Nanny Application
 

Please Fill out or Print and Mail/ Fax each of the (7) forms listed above.
1.Nanny Application

Please fill out the following. Use the tab key or mouse to move between fields.
Please note that we do not do summer placements. We only handle long-term commitments. Thank you.
Please answer the questions thoroughly and check for spelling/grammatical errors.
This application will be read by prospective families seeking nannies for employment.
Your Name: 
Street address: 
City or town:  State:  Zip: 
Phone number: 
E-mail address: 
Emergency Contact Info: 
 
POSITION APPLYING FOR:
Do you prefer to..  Live-in.  Live-Out. 
Preferred start date: 
Can you make a one year commitment?  Yes.  No. 
Are you legally able to work in the United States?  Yes.  No. 
 
PERSONAL PROFILE:
Do you have a driver's license?  Yes.  No. 
Can you drive:  Automatic shift.  Standard shift. 
Do you own a car that you would want to bring with you?  Yes.  No. 
Have you had any speeding tickets, moving violations, or accidents within the last 10 yrs? If yes, explain. 
Yes.  No.  Explanation:
Do you swim?  Yes.  No. 
Are you certified in CPR?  Yes.  No. Date:
First Aid?  Yes.  No. Date:
Do you have a criminal record? If yes, please explain.  Yes.  No.  Explanation:


Personal Profile comment area:

 
EDUCATION:
School & City/State Dates Graduated? Major
High School
College
College
Other
 
CHILDCARE EMPLOYMENT:
Please tell us about your childcare experience, including ages of children when you began caring for them
and hours per week worked. If this employer can be a reference for you, enter Yes under Ref?. 
Family Phone Dates Ages of
Children when you began		 Ref?
Family
Family
Family
Family
 
OTHER EMPLOYMENT:
(Last two positions other than childcare) 
Dates From / To Employer Phone Position Duties Ref?
1.
2.
 
OTHER REFERENCES:
Please add 2 references of your choice, i.e., High School or College
teacher or counselor, neighbor, church or synagogue member, etc. 
Dates Known Reference Phone Relationship to You
*.
*.
 
HEALTH INFORMATION:
Do you have any physical disability which would prevent you from performing specific kinds of work?  Yes.  No
. 
If yes, please explain the work limitations.

Do you smoke? If yes, please specify amount.  Yes.  No. 
Are you now, or have you been treated for a drug or alcohol habit?  Yes.  No. 
Are you now, or have you been treated for an eating disorder?  Yes.  No. 
Do you have or have you ever been told that you have allergies (i.e., to pets)  Yes.  No. 
Health comment area:



 
CHILDCARE RELATED:
Please check the ages of children you would like to care for as a nanny.
Newborn.  Toddlers (1-3).
Preschool(3-5).  Elementary(5+). 
What methods of limit setting do you now use with children?


Do you have any experience working with a special needs child? Yes.  No. 
If yes, please describe.



 
SITUATIONS: (What would you do if... )

Today a baby is crying frequently?



A 2 yr. old has a tantrum when asked not to touch his older brother's Lego project?

A 3 year old child marks up a wall with a crayon?

An 8 year old is acting surly and is unwilling to do any responsibilities, i.e., homework, picking up toys?

 
Comments or questions...


Please answer the questions thoroughly and check for spelling/grammatical errors.
This application will be read by prospective families seeking nannies for employment.

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press this button:


(It may take up to one minute for your information to be submitted. Please be patient!)