Nanny Application

This is the application for becoming a nanny through High Country Nannies. Your answers may be seen by the families who may be hiring you, so please make an effort to spell correctly and use proper punctuation.

AS YOU ARE FILLING OUT THE FORM, PLEASE DO NOT HIT THE "ENTER" BUTTON ON YOUR COMPUTER AS THIS WILL SUBMIT YOUR APPLICATION (if this happens, don't panic; simply hit the back button and continue to fill out the application). TO SUBMIT THE APPLICATION, HIT THE "SUBMIT" BUTTON WHEN YOU'RE DONE. Before filling out the form, make sure you have read my nanny page which includes the requirements for becoming a nanny. Please do not skip the section that asks for references. I cannot place a nanny without references. If you skip this section I cannot consider you for placement with my agency.

After submitting this application, I will contact you within 48 hours. Feel free to call or email me if you have any questions - 303-444-4881. Thank you for your interest in High Country Nannies!

       

Today's Date:

Job # you're applying for (if any):

Last Name:

First Name:

Middle Initial:

Maiden Name:

Other names you have gone by:

Present Address:

Street Address:

 
 

Apartment#:

 
 

City:

State:

 

Zip Code:

 
 

Home Phone:

 
 

Work Phone:

 
 

Cell Phone:

 

Date of Birth:

E-Mail Address:

   

In case of an emergency, please notify (include name and phone#):

How did you hear about us?

What states have you lived in the past two years?

Are you legally eligible to work in the United States?

Have you registered with us before?

If Yes, when?:

Position applying for (check all that apply):
Full-time Nanny Live-in Nanny Household Manager Housekeeper On-call Babysitter
Part-time Nanny Live-out Nanny Personal Assistant Temporary
Summer Travel

Geographic areas preferred:

No preference

Could start work:

Could work until at least:

Hours and days you're available: Monday       From   to 
Tuesday      From   to 
Wednesday From   to 
Thursday     From   to 
Friday         From   to 

Maximum number of children, regularly part of household, you a willing to care for:

I prefer to work with children from ages

I am experienced with children of the following ages (Check all that apply):
Newborn to 9 months
9 months to 24 months
2 to 5 years old
5 to 10 years old
older than 10 years
Special Needs/Disabled
What do you enjoy doing in your free time?
How would you describe your personality?
What have you done in the past two years?
What are you doing currently?
Do you smoke? Yes No
Are you willing to work with a family that smokes? Yes No
Will you work evenings? Yes No
Will you work weekends? Yes No
Are you CPR/First Aid certified (must be current)? Yes No
If No, are you willing to complete CPR/First Aid classes? Yes No
Are you experienced and willing to help with the following household chores should they become part of your job description?
General Housekeeping Laundry Ironing
Prepare simple family meals Grocery Shopping Running Errands
Do you have children that live with you? Yes No
If so, are you responsible for their care? Yes No
What are their ages?
Do you have visible tattoos? Yes No
Do you have face piercings? Yes No
If you have face piercings, are you willing to remove them if the client asks you to? Yes No
Do you have a criminal record? Yes No
If "Yes" Explain:
Do you have a valid driver's license? Yes No

Driver's license #:

Has your license ever been revoked or suspended? Yes No
If "Yes" Explain:
Have you ever been charged and/or convicted of a DUI or DWI? Yes No
Do you have a car? Yes No

If Yes, year, make and model:

Name of insurance company:

Accidents/Violations?: Yes  No
If "Yes" Explain:
Give names, phone numbers and addresses of three families (if possible) that you have baby-sat, nannied or done housekeeping for. Childcare center references also accepted:
Name of Family 1
Street Address
Apartment#
City
State: Zip Code  
Home Phone Work Phone
How long did you work for this family (give starting and ending dates)?
How many children did you care for?
What were their ages when you began?

What were your responsibilities?

What was your schedule?

Why did you leave?


Name of Family 2
Street Address
Apartment#
City
State: Zip Code  
Home Phone Work Phone
How long did you work for this family (give starting and ending dates)?
How many children did you care for?
What were their ages when you began?

What were your responsibilities?

What was your schedule?

Why did you leave?


Name of Family 3
Street Address
Apartment#
City
State: Zip Code  
Home Phone Work Phone
How long did you work for this family (give starting and ending dates)?
How many children did you care for?
What were their ages when you began?

What were your responsibilities?

What was your schedule?

Why did you leave?

Highest Level of Education:
High School Diploma
Some College
College 2 year Degree
College 4 year Degree
Subjects of special study:

What are some of your goals for the future?

Most families seek a nanny who is able to make a one year commitment. At the time you are ready to start working as a nanny, will you be able to make a one year commitment?
If "No" Explain:
Have you done any volunteer work?
If Yes, Explain:
Tell us about any other child care experience you have (childcare centers, camps, etc.), why you want to be a nanny, and what you uniquely have to offer as a nanny:
$ to $ per hour to start.
Salary open or negotiable.
As a part of our service to our families we ask you to undergo a criminal background and DMV check. If you are placed with a family, do you agree to let us run these checks?
Yes   No
BY CLICKING ON THE SUBMIT BUTTON, I AFFIRM THAT I AM THE PERSON LISTED ABOVE AND ALL INFORMATION PROVIDED IS TRUE IN ITS ENTIRETY.

Important note: After hitting the submit button you will be taken to a page that shows the answers you submitted. Please copy the answers into an email and save them for your own records.

Thank you!
Home