Application to Become a Nanny Nexus Nanny

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Present Phone: Permanent Phone: Work Phone:
Best time to call:
Can we call you at work?
- Yes
- No
Email
Are you eligible to work legally in the US?
- Yes
- No
Best time for an interview?
In case of an emergency who should we contact?
First Last
Emergency Contact's Phone Number:
Placement Preferences
Applicants must be able to make a one-year commitment for a permanent placement.
List
Date you could begin work: Salary Request:
Would you consider staying longer than one year?
- Yes
- No
What are you currently doing?
Why are you making a change?
Please check job opportunities that you would be interested in:
- Nanny Full-time
- Nanny Part-time
- Summer Nanny
- Pet Care
- Compassionate Companion
- Mother's Helper
- Childcare Overnights
- Group Care
- Childcare Call-in
- Handyman
Please check the family situations that you would be willing to work in:
- Working Mother
- Single Mother
- Non-working Mother
- Mother Working in Home
- Working Father
- Single Father
- Non-workin Father
- Father Working in Home
Please check the ages of children that you would like to work with:
- Newborns (0-6 months)
- Infant (7 months-1 year)
- Toddler (1- 2½ years)
- Preschool (2½-6 years)
- School age (6+ years)
- All of The Above
What is your favorite age group to work with?
Do you have experience with newborns?
- Yes
- No
What is the maximum # of children you would care for?
Check the following that you would care for:
- Multiples (twins, triplets)
- ADHD
- Handicapped
- Special Needs
Do you have a fear, dislike, or allergies to pets?
- Yes
- No
If yes, tell us about it:
How would you prefer your employer's home to be?
- Meticulously
- Very Neat
- Average
- No Preference
Driving Background:
Do you drive?
- Yes
- No
If yes, how long have you been driving?
Can you drive a stick shift?
- Yes
- No
Will you drive your own car or will you require the use of a family car?
- Own Car
- Family Car
If using your own car, what is the:
Year: Make: Model:
What is your driver's license #:
Exp. Date:
MM slash DD slash YYYY
State license is issued in:
In the last 5 years have you had a license issued in another state?
- Yes
- No
If yes, what state(s):
Do you have any speeding tickets, any other motor vehicle violations, been in a car accident that you received a ticket for, or had you license suspended?
- Yes
- No
If yes, tell us about it:
Personal Background:
Have you ever been arrested found guilty for a crime?
- Yes
- No
If yes, tell us about it:
What are your future goals professionally?
What are your future goals personally?
Besides a nanny opportunity are there any other jobs you are currently pursuing?
What are your hobbies and interests?
Do you speak a foreign language?
- Yes
- No
If yes, which one(s):
Do you have any visible tattoos or piercings?
- Yes
- No
Do you swim?
- Yes
- No
Do you cook?
- Yes
- No
If yes, tell us about your level and desire to cook:
Did you experience any form of neglect of abuse as a child?
- Yes
- No
If yes, please explain:
What did you enjoy most about your parents' parenting skills?
What are your personal strengths?
What are your personal weaknesses?
Education:
1. Highschool
School:
Location:
Yrs Attnd Date Graduated:
Degree:
2. College
School:
Location:
List
Yrs Attnd: Date Graduated:
Degree:
3. Other
School:
Location:
Yrs Attnd: Date Graduated:
Degree:
Major(s) Studied:
List any extra- curricular activites in highschool and/or college:
Are you currently attending college?
- Yes
- No
Nanny Experience:
Tell us about any early education classes or experiences that you have had:
Have you been a nanny before?
- Yes
- No
If yes, how many times?
Are you CPR or First Aid certified?
- Yes
- No
If not, are you willing to be?
- Yes
- No
If yes, can you provide proof?
- Yes
- No
Childcare Experience (start with present or last position):
Childcare Experience #1
From: To:
Family or Organization:
Length of time/frequency: Ages of children:
Address:
Home Telephone #: Work Telephone #:
Childcare Experience #2
From: To:
Family or Organization:
Length of time/frequency: Ages of children:
Address:
Home Telephone #: Work Telephone #:
Childcare Experience #3
From: To:
Family or Organization:
Length of time/frequency: Ages of children:
Address:
Home Telephone #: Work Telephone #:
Childcare Experience #4
From: To:
Family or Organization:
Length of time/frequency: Ages of children:
Address:
Home Telephone #: Work Telephone #:
Other Employment:
Other Employment #1:
From: To:
Employer:
Job Description:
Supervisor:
First Last
Phone:
Other Employment #2:
From: To:
Employer:
Job Description:
Supervisor:
First Last
Phone:
Other Employment #3:
From: To:
Employer:
Job Description:
Supervisor:
First Last
Phone:
Other References (other then child care, friends, or relatives):
Reference #1:
Name:
Relationship To You:
Home Phone: Work Phone:
Reference #2:
Name:
Relationship To You:
Home Phone: Work Phone:
Reference #3:
Name:
Relationship To You:
Home Phone: Work Phone:
*
- I agree that all of the information on this application is true to the best of my knowledge.
I CERTIFY THAT THE ANSWERS GIVEN HEREIN AND THE INFORMATION PROVIDED ARE FACTUAL, TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT FALSIFICATIONS, OMISSIONS OR MISREPRESENTATIONS MAY BE CAUSE FOR REJECTION OF MY APPLICATION TO Nanny Nexus LLC. OR ANY OF ITS CLIENTS, AND IF EMPLOYED BY A CLIENT OF NANNY NEXUS LLC. MAY BE CAUSE FOR IMMEDIATE DISMISSAL IF DISCOVERED AFTER MY EMPLOYMENT. I AUTHORIZE INVESTIGATION OF ALL INFORMATION CONTAINED IN THIS APPLICATION AND ANY SUPPLEMENTAL MATERIAL SUPPLIED BY ME AS MAY BE NECESSARY. I FURTHER AUTHORIZE ANY EMPLOYER, PERSON, CORPORATION, OR EDUCATIONAL INSTITUTION LISTED HEREIN, INCLUDING NANNY NEXUS LLC, TO ANSWER ANY AND ALL QUESTIONS AND AGREE TO HOLD ALL PERSONS HARMLESS FOR PROVIDING ANY AND ALL INFORMATION WITHIN THEIR KNOWLEDGE OR RECORDS.

Electronic Signature: By selecting submit, you hereby verify that the above information is accurate. If not, please select cancel.

Placement Preferences

Driving Background:

Personal Background:

Education:

Nanny Experience:

Childcare Experience (start with present or last position):

Other Employment:

Other References (other then child care, friends, or relatives):

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