Apply For a Position

Primary Details

Name*

First Last

Maiden Name*

Date of Birth*

Email Address*

Enter Email Confirm Email

Home Phone*

Cell Phone

Address*

Street Address Address Line 2 City State ZIP Code

Approximate Location (where you are near).*

When are you available to start a position?*

Are you willing to make a one-year commitment to a permanent position?*

Yes
No

Are you currently employed?*

Yes
No

Availability

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday Availability:

Tuesday Availability:

Wednesday Availability:

Thursday Availability:

Friday Availability:

Saturday Availability:

Sunday Availability:

Please check positions you are interested in:

Nanny
Mother's Helper
Family Assistant
House Manager
Housekeeper/Nanny

Please choose one:

Full Time Only
Part Time Only
Full Time or Part Time
Only Available for the Summer

Please choose one:

Live In
Live Out

Please describe yourself and your interests:*

Please tell us about your childhood:*

For example: Number of siblings? How were you disciplined? Relationship with your parents? Where did you grow up?

Comment on how you would react in the following situation: The 3-year-old you are caring for had a very loud tantrum in the middle of the store because she could not have the toy she wanted.*

If you were a parent looking for a childcare provider, what characteristics would you look for in a provider?*

Please write a short autobiography describing your experience as it applies to your desire to begin or continue a career as a professional childcare provider and explain why you believe you are qualified to be a nanny.*

Work History

Begin with most recent position and include full-time or part-time nanny positions. Please complete even if resume is included.

*Name of Employer

Contact Name

Phone Number

City/State

Position/Title

Start Date

End Date

Duties

Age(s) of Children

if applicable

Age(s) of Children

Beginning Salary

Ending Salary

Benefits

Reason for Leaving

May we contact this employer?

Yes
No

If no, reason:

Name of Employer

Contact Name

Phone Number

City/State

Position/Title

Start Date

End Date

Duties

Age(s) of Children

if applicable

Age(s) of Children

Beginning Salary

Ending Salary

Benefits

Reason for Leaving

May we contact this employer?

Yes
No

If no, reason:

Name of Employer

Contact Name

Phone Number

City/State

Position/Title

Start Date

End Date

Duties

Age(s) of Children

if applicable

Age(s) of Children

Beginning Salary

Ending Salary

Benefits

Reason for Leaving

May we contact this employer?

Yes
No

If no, reason:

Childcare References

Name*

Relationship to you*

Dates*

Home Phone*

Cell Phone

Ages of Children*

Name*

Relationship to you*

Dates*

Home Phone*

Cell Phone

Ages of Children*

Name

Relationship to you

Dates

Home Phone

Cell Phone

Ages of Children

Education Background

High School

City/State

Did you graduate?

Yes
HSED
No

Year of Graduation

College

City/State

Level Completed

Major/Minor

Diploma/Degree

Dates Attended

Other

Early Childhood Courses, Certifications, Etc

City/State

Courses/Titles

Certifications

Dates Attended

Questions

Do you have a valid US Driver's License?*

Yes
No

Do you own a vehicle?*

Yes
No

If yes, type of car and year:

Are you a U.S. Citizen or possess legal work documentation?*

Yes
No

Do you have infant care experience?*

Yes
No

Do you have children of your own?*

Yes
No

If yes, ages:

Are you looking for a position that would allow you to bring your own children?*

Yes
No

Are you bilingual?*

Yes
No

If yes, please list language(s):

Do you have experience with multiples (twins, triplets, etc)?*

Yes
No

Do you have experience working with special needs?*

Yes
No

If yes, please explain:

Are you willing to work with a stay-at-home parent?*

Yes
No

Are you CPR/First-Aid Certified?*

Yes
No

If no, are you willing to become certified?

Yes
No

Can you swim?*

Yes
No

Do you have cooking skills?*

Yes
No

Could you prepare meals nutritious for the children?*

Yes
No

Could you prepare meals for the entire family?*

Yes
No

Comments:

Do you smoke?*

Yes
No

Do you have any allergies to pets?*

Yes
No

If yes, type:

Do you have a reliable means of transportation?*

Yes
No

Do you have any major driving infractions or tickets?*

Yes
No

Have you ever been convicted of a felony or misdemeanor?*

Yes
No

If yes, please explain:

Do you have any pending criminal charges or civil lawsuits?*

Yes
No

Are you presently taking any medication(s), prescribed or not, which affects your judgment, coordination, levels of alertness and ability to respond to an emergency or care for children?*

Yes
No

If yes, please explain:

Do you have any physical condition that might impair or prevent your ability to perform any reasonably required physical act normally required in the care of children?*

Yes
No

If yes, please explain:

Do you have any mental condition that might impair or prevent your ability to protect a child from harm that could impair your judgement?*

Yes
No

If yes, please explain:

AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATION REPORT

I, the undersigned consumer, do hereby authorize Nanny Connections, by and through its independent contractor, US INFORMATION SEARCH. (ï¿½USISï¿½), to procure a consumer report and/or investigative consumer report on me.

These above mentioned reports may include, but are not limited to, employment and education verification, personal references, citations, a social security number verification, present and former addresses, criminal and civil history/record; and any other public record; and any other information bearing on my credit standing, credit capacity, worthiness, character, general reputation, personal characteristics, trustworthiness and/or mode of living.

I understand that the investigative consumer report I have authorized above may include information obtained by interviews with my neighbors, friends and/or associates and/or others with whom I am acquainted or who may have knowledge concerning said information. I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any investigative consumer report prepared on me upon written request to USIS that is made within a reasonable time after the date hereof.

I further authorize any person, business entity or government agency who may have information relevant to the above to disclose the same to Nanny Connections, by and through USIS, including but not limited to, any courthouse, any public agency, any and all law enforcement agencies and any and all credit bureaus, regardless of whether such person, business entity or government agency compiled the information itself or received it from other sources.

I hereby release Nanny Connections, USIS and any and all persons, business entities and government agencies, whether public or private, from any and all liability, claims and/or demands, of whatever kind, to me, my heirs, or others making such claim or demand on my behalf, for procuring, selling, providing, brokering, and/or assisting with the compilation or preparation of the consumer report and/or investigative consumer report hereby authorized.

Full Name

First Last

Complete Residence Address

Daytime Telephone Number

Driver's License Number

State Issued

Social Security Number

Date of Birth

Gender

*This information is voluntary. However, without this information, we will be unable to properly identify you in the event we find adverse information during the course of our background investigation.

How did you hear about Nanny Connections?*

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.

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