Nanny Employment Application

Personal Information
Name*:
Address:
City: State: Zip:
Email*:
Home Phone*:
Cell Phone:
How would you like us to contact you?

Email
Home Phone
Cell Phone
Home Fax:
Living Status: Live in
Live out
   
   
Are you legally able to work in USA? Yes
No
Do you have a drivers license? Yes
No
Do you own a car? Yes
No
Will you be bringing your car to work? Yes
No
   
   
Please list any foreign language spoken:
Are you CPR certified? Yes
No
First Aid? Yes
No
Desired salary?
Do you have health insurance? Yes
No
Desired start date:
 
 
Education
High School Year graduated:
College Year graduated:
City and State of College
Degree/Major
Did you receive a degree? Yes
No
 
 
Childcare Experience
Please list ALL childcare experience including volunteer, internships, student teaching, long-term babysitting, etc.
Name of Company /Family
Date employed
Position
Reason for leaving?
Contact phone numbers
May we contact them at this time?

Yes
No

 
 
Name of Company /Family
Date employed
Position
Reason for leaving?
Contact phone numbers
May we contact them at this time?

Yes
No

 
 
Name of Company /Family
Date employed
Position
Reason for leaving?
Contact phone numbers
May we contact them at this time?

Yes
No

 
 
Please list any additional childcare experience below:
Newborn? Yes
No
Infants? Yes
No
Toilet training? Yes
No
School age children? Yes
No
Children with special needs? Yes
No
   
 
Short Essay Questions
1. What qualities should a successful nanny possess?
 
 
2. If you have never been a nanny before, please explain why you wish to pursue this opportunity.
 
 
3. How long are you looking to stay at a position?
 
 
4. What are your future goals?
 
 
5. What kind of hobbies do you have? What do you like to do in your spare time?
 
 
6. Please list activities you like to do with children?
 
 
7. What is your current health status?
 
 
Are you willing to travel with a family? Yes | No
Have you ever been convicted of a crime? Yes | No
Do you smoke? Yes | No
Can you swim? Yes | No
Do you drink? Yes | No
 
 
Please explain your philosophy on discipline?
 
 
Please tell us your best and worst childcare experience?
 
Is there anything else you thing we or the family should know about you?
 
 
Additional Non-childcare Work History:
Employer
Date employed
City/State
Position
Contact phone number
May we contact them at this time? Yes
No
Reason for leaving?
 
 
 
Employer
Date employed
City/State
Position
Contact phone number
May we contact them at this time? Yes
No
Reason for leaving?
 
 
Character References:
Name
Phone
Address
Relationship
 
Name
Phone
Address
Relationship
 
Name
Phone
Address
Relationship
 
Name
Phone
Address
Relationship
   
 
How were you referred Potomac Nannies and More???
   
Upon submitting this form, I herby attest that all of the above information is true and accurate. I have given full disclosure of my entire work history to Potomac Nannies and More. I further agree that I will not accept employment from any Potomac Nannies and More client or referral of Potomac Nannies and More without the express permission of Potomac Nannies and More.
   

* Required fields

 

 


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