Nanny Application for a Family

Name  
*(required)
E-mail  
*(required)
Address  
City  
State/Province  
Zip  
Country  
Daytime Phone     Ext.
Best Time to Call  
Evening Phone  
Best Time to Call  
1. When are you available to start work?

2. Years of Professional Child Care Experience:  
3. Type of experience: (Include nanny, babysitter, teacher,
camp counselor, tutor, etc.)
4. Name of most recent child care reference (of 1 year or more):
5. Reference Phone:   Ext.
Yes    No    6. Are you a high school graduate?
Yes    No    7. Are you a college graduate?
Yes    No    8. Do you drive a car?
Yes    No    9. Do you smoke?
Yes    No    10. Would you be willing to relocate to Florida?
Yes   
No   
11. Are you willing to commit to a one-year employment contract?
Yes    No    12. Are you willing to work in a home with pets?
Yes    No    13. Are you a U.S. citizen?
Yes    No    14. If not, are you a resident alien?
Interested in position (check all that apply):
Nanny Mother’s Helper
Elder Care Prepare Meals
Light Housework Complete Housework
Driving Running Errands
Live In Live Out