Not Used Application

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Name *

First

Last

Maiden Name (If Applicable) *

Phone Number *

Email *

Upload Resume *

Max file size: 20MB

Street Address *

Date of Birth: MM/DD/YYYY *

Emergency Contact Name *

Emergency Contact Phone Number *

Please include a photo for your profile *

Max file size: 20MB

Date available to start MM/DD/YYYY *

How long have you nannied previously *

Full-Time for a year or more Part-Time for a year or more Babysitting for a year or more No Previous Paid Experience

Are interested in temporary paid work through our agency while we are searching for your future position? *

Yes No Maybe

Can you make a One Year commitment *

Yes No

Marital Status *

Single Married

Are you a Smoker *

Yes No

Do you have a valid Drivers License *

Yes No

Drivers License Number *

Please list the Make and Model of you Vehicle *

Please list your Car Insurance Provider Company *

Has your license ever been revoked *

Yes No

Please share what is motivating you to be a nanny at this time *

Are you willing to get a Flu Shot *

Yes No

Have you ever been treated for alcoholism *

Yes No

Have you ever had a seizure previously *

Yes No

Have you ever been arrested or charged with a criminal charge? ie (DWI) *

Yes No

If Yes, Please list below *

Please list any medications you take on a regular basis *

Are you willing to take a drug test if required by a family? *

Yes No

Are you a United States Citizen? *

Yes No

If no, what type of Visa do you have? *

Please describe your Health Style? *

Excellent Fair Poor

Please share an overview of your family life values and upbringing *

What hours are you able within on Monday? ( example 7-6 ) or any please note if you put a specific time people will potentially not contact you. So it is recommended to show full availability *

What hours are you available to work on Tuesday? *

What hours are available to work on Wednesday *

What hours are you available to work on Thursday *

What hours are you available to work on Friday *

What hours are you available to work on Saturday *

What hours are you available to work on Sunday *

Please outline any extra activities, in your life that may interfere with your work hours? *

Are you looking to take any nanny training courses that we would provide? i.e. (CPR, First Aid) *

Please list a few traits in your personality that would make you a great nanny? *

Have you ever been convicted of a crime? *

Yes No

Date of Crime (if applicable) *

Do you have any Health Concerns that would prevent you from being able to fulfill your job requirements? *

Please list do you have any tattoos's? *

Choose *

I have a Small tattoo I have a Large tattoo I have a tattoo that is primarily covered I have many tattoos

Please list your hobbies and personal interest *

Please select all areas you are willing to work in *

Minneapolis St. Paul Western Suburbs (Minnetonka, Plymouth, Maple Grove, Eden Prairie, Chanhassen ) Southern Suburbs (Burnsville, Eagan, Apple Valley, Prior Lake, Lakeville) Northern Suburbs (Anoka, Ramsey, Coon Rapids, Blaine, White Bear) Eastern Suburbs (woodbury, Oakdale, Stillwater, Cottage Grove, Dellwood, Arden Hills)

Please enter your Favorite task to do while nannying *

Please list your employer *

Please list your employer's phone number and email *

Please list your work history / job description overview below *

Please list your employer *

Please list your employer phone number and email *

Please list your work history / job description overview below *

Please list your employer *

Please list your employ phone number and email *

Please list your work history / job description overview below *

Please list your employer *

Please list your employer phone number and email *

Please list your work history / job description overview below *

Have you ever been instructed in CPR / First Aid? *

Yes No Yes, but no longer valid certificate

Reference contact #1 We need at least five references email in order to process your account. These can be work, personal or family *

Reference Contact #2 *

Reference Contact #3 *

Reference Contact #4 *

Reference Contact #5 *

If a child threw a tantrum in a store, what would you do? *

If you were having a conflict with child care beliefs with your nanny family , what would you do? *

What would you do if you found suspicious marks on a child you nanny for? *

How would you react in an emergency situation? (Cuts / Choking / Other) *

To whom do you talk to if you are having problems with you nanny family? *

Describe any problems that might occur with any family you might have? *

Do you feel easily adaptable to new situation? *

Yes No Maybe

Do you suffer or have you ever had depression? *

Yes No

What are your favorite ages of children to work with? *

Infants 1 - 3 Years Old 4 - 5 Years Old School Age

Please rate your energy level *

High Average Low

Are you willing to do a training day ( following another nanny ) ? *

Yes No

Would you be interested in taking a child development course through our agency? *

Yes No Maybe - If Requested

Do you have any problems working for a family that does not does not allow there children to watch TV? *

Yes No

Please select the option that fits you the best *

'Very Reliable' 'Reliable' 'Sometimes Reliable'

On average how many sick days have you taken in the last year? *

0 - 1 1 - 2 3 -4 5+

Do you have any children of your own? *

Yes No

If you do have children, would they need to accompany you on the job? (Most of our families do not allow this) *

Yes No

What are your goals in the next 5 years? *

What are (3) attributes that make you a great Nanny to work with? *

Max miles/distance willing to commute? *

Years of Infant Experience *

Years of Toddler Experiece *

Years of Preschooler Experience *

Years of School Age Experience *

Years of Special Needs Experience *

Years of Overnight Care Experience *

Years of Multiples Experience *

High School Attended *

Did you receive a diploma? *

Yes No GED

College *

Please state your Degree / Major (If Applicable) *

I ATTEST THAT THE INFORMATION GIVEN ON ALL FORMS PRESENTED TO ME TODAY IS TRUE TO THE BEST OF MY KNOWLEDGE *