Name (first, last):
Age: * must be 21 to apply
Address:
City:
State: Zip:
Phone:
e-mail:
Date available to start work? (mm/dd/yy)
Desired Salary Range?

I can provide at least 3 child care references: Yes No

I can provide at least 2 character references: Yes No

I own a vehicle: Yes No

I have auto insurance: Yes No

I have a clean driving record: Yes No

If no, please explain:



Have you ever been convicted of a crime (adult or juvenile)?:
Yes No

Position seeking (check all that apply):

Infant Care	Full Charge Nanny
Estate management	Personal Assistant
In home tutor/teacher	Temporary Nanny
Light Housekeeping	Travel Nanny
Cooking	Mother's Helper

Type of position (check all that apply):

Full Time	Part Time
Summer	Temporary

My experience consists of (check all that apply):

Current Professional Nanny	Former Professional Nanny
Daycare Assistant	Pre-school Assistant
School Directory	Teacher Certification
Babysitting	Overnight Care
Camp Counselor	Sunday School Teacher
Cared for Siblings or family members

My eductation consists of (check all that apply):

High School Diploma	Some College
2 year degree	4 year degree If so what major?

My degree concentration is in:

Graduation Work	Workshops/certification
CPR Completion	First Aid Completion

Additional Qualities:

Music Training	Art Training
Above Average Swimming Ability	Foreign Language if so, which language?
Special Needs Care

Please complete the following Sample Essay Questions: Please give a detailed description of your childcare experience.



What do you see as the nanny's role in the family?



*Please note this is an initial application form. An extended application must be completed upon acceptance for interview. Please check over the information in this form now.