INSTRUCTIONS:

  1. This may take an hour or more to fill out. Be prepared to fill out this application in its entirety.
  2. Please be as thorough as possible in each section.
  3. Make sure you have all phone numbers for references available because this is very important to include in your application.
  4. When filling in your answers in a text box, DO NOT hit your 'Enter' or 'Return' keys. Just type as your text will wrap automatically.
  5. Your Name and Email Address are required fields.
  6. Please click on the 'Submit' button only once.
  7. Make sure that you mail us a recent photo of yourself as soon as possible. We are anxious to work with you. Our address is at the bottom of this page.
NANNY APPLICATION
Today's Date:

Full Name: (Required)
 Email Address: (Required)
Present Address:

City:
State: Zip:
Present Phone: 		Permanent Address:

City:
State: Zip:
Permanent Phone:
Work #:
Can we call you at work?
 If Yes, work hours:
 Best time to call:
Height (optional):
 Weight (optional):
 Age:
 Date of birth:                 
PLACEMENT PREFERENCES
Date you could begin work:
 Salary requested:
Where do you want to be placed?
 Anticipated length of stay:
(minimum of one year required) 		Will you consider staying longer than one year?
Yes
No		 Requested days off:
Flexible  
Sat./Sun 
Sun./Mon
Please indicate those family situations in which you would be willing to work (check all that apply):
Working mother
 Working father
 Single mother
 Single father
 Non-working mother
 Non-working father
 Mother working
at home
 Father working
at home
Please check the ages of children you would like to work with: (Check all that apply)
Newborn
(0 - 6mos)
 Infant
(7 mos - 1yr.)
 Toddler
(1 - 2½ yrs.)
 Preschool
(2½ yrs - 5yrs.)
 School age
(6 yrs +)
 All of the above
What is your favorite age group?
 Maximum number of children you would care for?
 Would you care for more children if one or more are in school all day?
Yes No		 Would you care for:   Twins   Triplets
  ADD or ADHD
  Handicapped
  Special Needs
Experience working with newborns?
 Pets: How do you feel about animals:
(like, dislike, fear, allergic)
DRIVING (We will do a DMV Report, please be accurate)
Do you drive?
Yes
No		 Number of years driving?
 Drive a stick shift?
Yes
No		 If Yes,
for how long?
 Do you require use of a car?
Yes
No		 Bringing your own car?
Yes
No		 If Yes,
year/model
Driver's license #
 Exp. Date: (mm/dd/yy)
 State license is issued:
Any drivers license(s) issued in another state within the last 5 years?
Yes No		 If so, what state(s)

Do you have any speeding tickets? Yes No
If Yes, how many and date ticket(s) received
 Any other motor vehicle violations? Yes No
If Yes, explain
Have you been in any car accidents? Yes No
If Yes, when and did you receive a ticket?
 Has your license ever been suspended? Yes No
If Yes, explain
PERSONAL AND FAMILY BACKGROUND
Father's name
 Mother's name
Number and ages of brothers and sisters in your family
 Have you ever been away from home for an extended period of time?
Yes  No
Do you own any pets?
Yes  No
If so, who will take care of them while you are a nanny?
 List all states you've lived in since age 18 including dates lived there and why
Are you involved with a boyfriend?
If Yes, explain (how long dating, where does he live, where will he be when you are a nanny, any marriage plans)
What is Your Religion?

Do you need time off to attend religious services?
Yes No
If Yes, when?

Do you need time off for school?
Yes No
If Yes, when?
What are your goals for the future?
 At this time are you searching for job opportunities other than being a nanny? Yes No
If Yes, explain
Do you have any allergies?
Yes No
If Yes, to what?
 Any dietary restrictions?
Yes No
If Yes, what?
What are your hobbies and interests?
 Do you speak a foreign language?
Yes No
If so, which ones:
Do you swim?
Yes No 		Are you a good swimmer?
Yes No 		Could you work in a smoking environment?
Yes No 		Do you request your own bathroom?
Yes No
Have you ever been married?
Yes No 		If Yes,
for how many years?
 Are You: divorced Yes
No		 widowed Yes
No		 separated Yes
No		 If Yes, for how many years?
 What is your maiden name?
Have you ever had a child?
Yes
No		 If Yes, how many children, their ages and where are they?
 Any immediate family members in poor health?
Yes
No		 If Yes, explain
Check all that apply that describes how well you cook:
Not at all
 Very limited
 Can follow through on planned menus
 Enjoy cooking
 Full meal preparation
 Baking and planning meals
 Gourmet cooking
Would you prefer your employer's home to be: Meticulously neat
 Very neat Average No preference
INDICATE YOUR INTERESTS BELOW:
Music
Very much Some-what Not at all 		Piano
Very much Some-what Not at all
Computers
Very much Some-what Not at all 		Art
Very much Some-what Not at all
Writing
Very much Some-what Not at all 		Reading
Very much Some-what Not at all
Sewing
Very much Some-what Not at all 		Shopping
Very much Some-what Not at all
Movies
Very much Some-what Not at all 		Swimming
Very much Some-what Not at all
Rollerblading
Very much Some-what Not at all 		Skiing
Very much Some-what Not at all
Sports
Very much Some-what Not at all 		TV
Very much Some-what Not at all
EDUCATION
  School and Location Phone # Dates Attended
(mm/dd/yy)		 Date
Graduated		 Degree
HIGH SCHOOL
COLLEGE
OTHER
Major(s) Studied
List any extra-curricular activities in high school and/or college
Are you currently attending college? Why are you or did you leave college?
EMPLOYMENT Start with you most recent or present job
From TO Employer Area Code & Phone Job Description Supervisor
Can we contact your present employer?
 If Yes, best time to call?
 Please explain any gaps in employment:
Have you ever been employed under any other last name?
If Yes, please specify:
CHILDCARE EXPERIENCE
Are you CPR or First Aid certified?
Yes No		 Have you been a nanny before?
Yes No
If Yes, how many times?
Dates and locations of each nanny position and all childcare references: (Start with present or last position)
From
 Family or organization
To
 Address
Length of time/frequency
 Home telephone #
Ages of children when you began
 Work telephone #
From
 Family or organization
To
 Address
Length of time/frequency
 Home telephone #
Ages of children when you began
 Work telephone #
From
 Family or organization
To
 Address
Length of time/frequency
 Home telephone #
Ages of children when you began
 Work telephone #
From
 Family or organization
To
 Address
Length of time/frequency
 Home telephone #
Ages of children when you began
 Work telephone #
From
 Family or organization
To
 Address
Length of time/frequency
 Home telephone #
Ages of children when you began
 Work telephone #
REFERENCES
Any other references such as daycare experience, nursery, babysitting, camp counselor, teacher's aide, etc.; if possible, 2 teachers or guidance counselors, clergy, NO FRIENDS OR RELATIVES.
Name Relationship To You Phone (home and work)
Is there any other information that you would like to add that would be helpful in placing you with the right family?
How did you hear about Nannies Plus?
I certify the facts contained in this application are true and complete to the best of my knowledge.
Name/Signature
 Date
NANNY WRITTEN INTERVIEW
What are you doing at present?
 Why are you leaving this position?

Do you think you will get homesick while being a nanny?
Yes No

 If so, how will you handle it?
 If you are living on your own, how long have you been away from your family?
Did you experience any form of neglect or abuse as a child?
Yes No
If Yes, please explain
 What did you like most about your mother/father's parenting skills?
What qualities would you look for if you were hiring a nanny?
 What do you see as your personality strengths?
What do you see as your personality weaknesses?
Please answer the following: (You may elaborate)
Describe your personality:
 Describe your relationship with your family:
Tell why you want to become a nanny:
HEALTH INFORMATION FORM
Do you smoke?
Yes No
If Yes, how many per day
 If requested, could you refrain from smoking in your family's home?
Yes No		 Do you take any frequent medication?Yes No
If Yes, please list
Do you have any physical restrictions, impairments or
congenital defects? Yes No
If Yes, please explain
 Are you currently under a physician's care? Yes No
If Yes, why
Do you consume alcoholic beverages? Yes No
If Yes, describe frequency
 Any hospital stays? Yes No
If Yes, when and why
Have you ever been treated for: (Check all that apply)
AIDS
Yes No		 Cancer
Yes No		 Heart Disease
Yes No		 Allergies
Yes No		 Diabetes
Yes No
Asthma
Yes No		 Leukemia
Yes No		 Sexually transmitted diseases
Yes No		 Convulsions
Yes No		 Other
Yes No
If you checked Yes for any of the above, please explain
If employing family requests, would you submit to: (Check all that apply)
Physical examination
Yes
No		 Drug screening
Yes
No		 HIV test
Yes
No		 Other
Yes
No
Are you presently covered by Health Insurance?
Yes No
If Yes, please list insurance company and policy number
In case of emergency, who should be contacted?
Name:
 Phone #
 Relationship to you:
Address:
Please check all that apply: Have you ever:
Been convicted of a misdemeanor or felony?
Yes
No		 Been on any medication for depression?
Yes
No		 Been the driver in a car accident?
Yes
No
If you checked any of the above questions, please explain in detail:
I hereby warrant that the facts stated above are true and complete and are made for the purpose of assisting me to secure employment.
In addition, I hereby authorize you to deliver Nannies Plus, Inc., P.O. Box 603, Chester, NY 10918, copies of my medical records and to disclose to them any information that you may have regarding my physical and emotional history and conditions.
Name/Signature(type)
 Date
Please note that clicking on the 'Submit' button is your confirmation that all of the information you are submitting is true to the best of your knowledge.

Once you click on the 'Submit' button, you will be taken to a BACKGROUND AND REFERENCE AUTHORIZATION page with a link at the bottom for the AGREEMENT & INTENT page.
You MUST print out both pages, fill in all blanks completely and mail by regular postal mail with a recent photo of yourself in order to continue your application process.

Please click on the 'Submit' button only once.

Thank you for completing the Nannies Plus Application.

Nannies Plus, Inc.
Office Hours: 10:00 am - 5:00 pm, Eastern Time
P.O. Box 603
Chester, NY 10918, USA
866-492-1039 | Fax 845-468-4404
Contact Form

©1986-2006, Nannies Plus, Inc. Nannies Plus is a trademark of Nannies Plus, Inc.
©1986-2006, Nannies Plus, Inc. All Applications - all rights reserved