Applicant

First name *

Please provide your first name.

Last name *

Please provide your last name.

Email *

Please provide your email address.

Phone *

Please provide your phone number.

Street address *

City *

State *

Zip / Postal Code *

Job position *

Which position are you applying for?

How did you hear about us? *

Are You CPR Certified *

Yes No

Are you interested in live-in positions? *

Yes No

What ages are you comfortable caring for? *

Newborn 0-2 years 3-5 years 6-8 years 8+ years

What is your Availability?

What is your desired Salary?

Do you have any certifications related to the job?

Do you have a driver's license? *

Yes No

Drivers License State, Number, and Expiration

Do you smoke? *

Yes No

Do you swim?

Yes No

Are you willing to work in a home with a parent home full-time? *

Yes No

Are you over 18? *

Yes No

Do you have a car? *

Yes No

Do you use your car for work purposes? *

Yes No

make, model, and year? *

How many miles are you willing to commute? *

Do you have car insurance? *

Yes No

Insurance company and coverage? *

All traffic citations over the last 5 years: *

Had any traffic citations, including DWI DUI? *

Are you eligible to work in the US? *

Yes No

Do you have a valid drivers license? *

Yes No

State your license issued? *

License number: *

Other states you had a license? *

Are you COVID vaccinated? *

Yes No

Have you ever been convicted of a moving violation, misdemeanor, or felony? If yes, explain * *

Tell us a little about yourself…

List 3 references *

Please include dates, names, phone number, and emails

Resume, CPR, & First Aid Certifications

Upload any documents here.

Upload an Image of yourself

Feel free to upload a profile image.

Employment History

Add your work history below. Click + to add more entries.

Job #1

Employer Name

Your Position

Start Date

End Date

Employer Phone

Employer Email

City

State

Job Description

When can you start? *

How many hours are you willing to work per week? *

Are you willing to work over 40 hours a week? *

Yes No

What appeals to you about being a nanny vs. working in a daycare/school setting? *

What extracurricular activities/special skills or hobbies are you interested in? *

Describe the type of family you would like to work for: *

What appeals to you about being a nanny vs. working in a daycare/school setting? *

What was your worst childcare experience and how did you resolve it? *

What do you find to be the most challenging part of working with children? *

Describe your last childcare experience and why it ended. *

Have you ever had to handle an emergency? If so, explain your reaction. *

How have you communicated about a child's daily activities in the past? *

Why are you interested in working in childcare? *

Do you speak more than one language? *

How many years of childcare experience do you have? *

What age will you care for? *

Would you care for children with special needs? *

Yes No

Have you cared for multiples? *

Willing to tutor? *

Science Math Reading Language None

What childcare tasks are you willing to perform? *

With respect to childcare, what activities would you organize on a daily or weekly basis? *

How many children will you care for? *

Would you care for sick children? *

Yes No

Will you assist with homework? *

Yes No

What household tasks are you willing to perform? *

What is your philosophy on discipline? *

What are the most important characteristics of a successful relationship between the childcare provider and the parents? *

How did you hear about us?

Do you know of anyone who would be interested in private service in a household?

How often would you like us to follow-up with you after placement *