The Nanny Authority - Nanny Application

"The Most DEDICATED & CARING Nannies"

Dear Nanny,

Please complete this on-line form or print this form and fax it to 1-973-466-1510. There is no charge to register with our service. We will contact you upon receipt, and we look forward to speaking with you!

* Required Information
Contact Information
First Name:	*
Last Name:	*
Street Address:
City:	*
State:	*
Zip Code:
Day Phone:	*
Evening Phone:	*
Fax:
E-Mail:

Date Available to Begin Work:	*
Where in the U.S. would you like to be placed?	*
Are you willing to relocate for a minimum of one year?	*

Are you seeking a full-time, live-in job?	*
Salary requested (weekly):	*
Have you ever been a nanny before?	*
If yes, where and for how long?

Are you in good health?	*
Do you have any allergies?	*
If yes, please list:
Do you take any prescription medications?	*
If yes, please list medication and why:
Do you smoke?	*

Do you drive?	*
Do you have any motor vehicle violations on your license?	*
If yes, specify:
Would you be able to bring a car with you?	*

What level of education have you completed?	*
If college, list your major?
If college, list your college and its location?
Have you ever been arrested?	*
If yes, please explain:
List the ages of children you will care for (i.e. toddlers, school age) (*):

Childcare Reference #1 (i.e. nanny jobs, babysitting, daycare) *
Employer Name:
Employer's Work Phone Number:
Employer's Home Phone Number:
Dates of Employment:
Job Description:

Childcare Reference #2
Employer Name:
Employer's Work Phone Number:
Employer's Home Phone Number:
Dates of Employment:
Job Description:

Childcare Reference #3
Employer's Name:
Employer's Work Phone Number:
Employer's Home Phone Number:
Dates of Employment:
Job Description:

Business Reference #1*
Company Name/Supervisor's Name:
Company's Phone Number:
Dates of Employment:
Job Description (position):

Business Reference #2
Company's Name/Supervisor's Name:
Company's Phone Number:
Dates of Employment:
Job Description (position):

Business Reference #3
Company's Name/Supervisor's Name:
Company's Phone Number:
Dates of Employment:
Job Description (position):

Briefly tell us about yourself (personality, goals, family background, why you want to be a nanny, etc.) (*):

How did you hear about us? Please list the specific newspaper, school, magazine or web site.
	Newspaper
	School
	Magazine
	Web Site
	Other