Caregiver Application The fields marked with (*) are required fields. * Full Legal Name  * required * Date Available  * required * Check Position Applying for: Part Time Full Time Temporary Live In Nanny Summer ONLY   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?  * required   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?