Nanny Application

• Personal Details

• Name *
  First Last

• Address *
  Street Address
  
  
  Address Line 2
  
  
  City
  
  
  State / Province / Region
  
  
  Postal / Zip Code
  
  
  Afghanistan Albania Algeria Andorra Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Country
• Citizenship *
• Home Phone # *
• Cell Phone #
• Email Address
  
  
  
• Date of Birth / MM / DD YYYY
• Position Sought *
• Position Type *
  --Choose One-- Live In Live Out Either
• When Available to Begin Work *
• Salary Desired *
• Are You Currently Employed * Yes / No
• May we Contact Your Present Employer * Yes / No
• Are You Either a U.S. Citizen or an alien authorized to work in the U.S. Yes No
• Alien Registration Number
• Do you have a driver's license? * Yes / No
• License Number
• State Issued:
• Do you own a car? * Yes No
• Year and Model:

• Education

• High School
• Number of years completed:
• Major or Degree:

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• College:
• Number of years completed:
• Major or Degree:

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• Business or Trade School:
• Number of years completed:
• Major or Degree:

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• Other School
• Number of years completed:
• Major or Degree:

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• Special Skills:
• Hobbies/Interests:
• Languages Spoken: *

• Employment History
  (Please list your last three employers starting with the most recent one first.)

• Name of Employer:
• Address:
• Contact Name:
• Contact Phone:
• Job Title
• Leaving Salary:
• Start Date: / MM / DD YYYY
• End Date: / MM / DD YYYY
• Duties Performed:
• Reason for Leaving:

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• Name of Employer:
• Address:
• Contact Name:
• Contact Phone:
• Job Title
• Leaving Salary:
• Start Date: / MM / DD YYYY
• End Date: / MM / DD YYYY
• Duties Performed:
• Reason for Leaving:

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• Name of Employer:
• Address:
• Contact Name:
• Contact Phone:
• Job Title
• Leaving Salary:
• Start Date: / MM / DD YYYY
• End Date: / MM / DD YYYY
• Duties Performed:
• Reason for Leaving:

  References
  Please supply the names of three persons not related to you, whom you have known for at least one year.

• Name *
• Address *
• Phone *
• Business

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• Name *
• Address *
• Phone *
• Business

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• Name *
• Address *
• Phone *
• Business

• Duties Prepared to Undertake

  Select All That Apply
  Infant Care Toilet Training Children's Laundry Children's Meals
  Driving Children Bathing Children Weekend Babysitting Evening Babysitting
  Bathing Elderly Adults Dressing Elderly Adults

  Family Meals Family Laundry Ironing Changing Linens
  Vacuuming Taking Messages Mopping Floors Cleaning Bathrooms
  Wearing Uniform Travel

  Serving at Table Cleaning Kitchen Making Beds Trash
  Dusting Errands Cleaning Windows Cleaning Garage
  Watering Plants Mending

• Days Off Required
  
  
  
• Do you have any physical limitations? Yes No
• Do you smoke? Yes No
• Have you ever been treated for Drug/Alcohol addiction? Yes No
• Are you currently undergoing any treatment? Yes No
• If 'Yes', please explain: