The Nanny Authority - Nanny Application

"The Most DEDICATED & CARING Nannies"

Dear Nanny,
Please complete and e-mail or fax back to us as soon as possible. There is no charge to register with our service. We will contact you upon receipt and we look forward to speaking with you!

First name:
Last name:
Street Address:
Day Phone:
Evening Phone:
Fax:
eMail:

How did you hear about us?
How did you find this web page?

Age: Height (optional): Weight (optional):
Physical fitness level:

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?	Yes No

Are you seeking a full-time, live-in job?	Yes No
Salary requested (weekly):
Have you ever been a nanny before?	Yes No
If yes, where and for how long?

Are you in good health?	Yes No
Do you have any allergies?	Yes No
If yes, to what are you allergic?
Do you take any prescription medications?	Yes No
If yes, which ones?
Do you smoke?	Yes No

Do you drive?	Yes No
Do you have any motor vehicle violations on your license?	Yes No
If yes, specify:
Would you be able to bring a car with you?	Yes No

What level of education have you completed?	Some High School Graduated High School or G.E.D Graduated High School 1 year of college 2 years of college 3 years of college 4 years of college More than 4 years of college
If yes to college, what was your major?
If yes to college, which college was it and what is its location?
Have you ever been arrested?	Yes No
If yes, please explain:
Ages of children you will care for (select as many as apply):	Newborn Infant Toddlers School Age All of the above

Childcare References (e.g. nanny jobs, babysitting, daycare, etc.)
1. Name of employer:
Work phone number of employer 1:
Home phone number of employer 1:
Dates of employment:
Job Description:

2. Name of employer:
Work phone number of employer 2:
Home phone number of employer 2:
Dates of employment:
Job Description:

3. Name of employer:
Work phone number of employer 3:
Home phone number of employer 3:
Dates of employment:
Job Description:

Business References
1. Company name/Supervisor's name:
Company 1's phone number:
Dates of employment with company 1:
Job description (position):

2. Company name/Supervisor's name:
Company 2's phone number:
Dates of employment with company 2:
Job description (position):

3. Company name/Supervisor's name:
Company 3's phone number:
Dates of employment with company 3:
Job description (position):

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

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