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My Nanny Rocks, LLC

Why Having A Nanny Rocks

Caregiver Application
*The field marked with () are required fields.**
*	Full Legal Name
*	Date Available
*	Check Position Applying for:	Part Time Full Time Temporary Live In Nanny
	How far are you willing to drive for a job?
*	Are you willing to commit to a family for at least one year?	Yes No
*	Would you be willing to work on a temporary basis(6 weeks)?	Yes No
*	Current Address:
*	How Long at Address?
	Home Phone
	Cell Phone
	Best Time to Call?
	Email Address
	Do you drive?	Yes No
	How long?
	Do you have a clean driving record?	Yes No
	How many accidents? Explain
	How many tickets? Explain
	Do you feel comfortable driving children?	Yes No
	What kind of vehicle do you drive?
	Two Door Four Door
*	Have you ever been convicted of a misdemeanor or felony? If yes, please explain.
	High School
	Graduated	Yes No
	Year Graduated
	College
	Dates Attended
	Graduated	Yes No
	Major/ Minor
	GPA
	CPR Certification	Yes No
	Expiration Date
	First Aid Certification	Yes No
	Expiration Date
	Work Availability and Preferences	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
	Hours
	Work Experience: Dates Employed Phone Number Reason For Leaving
	Work Experience: Dates Employed Phone Number Reason For Leaving
	Work Experience: Dates Employed Phone Number Reason For Leaving
*	Childcare Reference Include Phone Number and Reason For Leaving
*	Childcare Reference Include Phone Number and Reason For Leaving
*	Childcare Reference Include Phone Number and Reason For Leaving
*	Please initial that all the information you have provided is true and correct to the best of your knowledge. If an interview is scheduled an actual signature will be required for permission to check references.
*	Please write a short paragraph describing what kind of position you are looking for (i.e. family, children, household duties, etc.)
	Is there another name you like to go by? If so please tell us
	How did you hear about us?

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