Nanny Nexus Provider Application - FL

Nanny Application - FL

Please use this form to Apply for a Nanny position

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Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Present Phone:

Permanent Phone:

Work Phone:

Best time to call:

Can we call you at work?

Yes

Are you eligible to work legally in the US?

Yes

Best time for an interview?

In case of an emergency who should we contact?

First Last

Emergency Contact's Phone Number:

Placement Preferences

Applicants must be able to make a one-year commitment for a permanent placement.

List

Date you could begin work:

Salary Request:

Would you consider staying longer than one year?

Yes

What are you currently doing?

Why are you making a change?

Please check job opportunities that you would be interested in:

Nanny Full-time

Nanny Part-time

Summer Nanny

Pet Care

Compassionate Companion

Mother's Helper

Childcare Overnights

Group Care

Childcare Call-in

Handyman

Please check the family situations that you would be willing to work in:

Working Mother

Single Mother

Non-working Mother

Mother Working in Home

Working Father

Single Father

Non-workin Father

Father Working in Home

Please check the ages of children that you would like to work with:

Newborns (0-6 months)

Infant (7 months-1 year)

Toddler (1- 2½ years)

Preschool (2½-6 years)

School age (6+ years)

All of The Above

What is your favorite age group to work with?

Do you have experience with newborns?

Yes

What is the maximum # of children you would care for?

Check the following that you would care for:

Multiples (twins, triplets)

ADHD

Handicapped

Special Needs

Do you have a fear, dislike, or allergies to pets?

Yes

If yes, tell us about it:

How would you prefer your employer's home to be?

Meticulously

Very Neat

Average

No Preference

Driving Background:

Do you drive?

Yes

If yes, how long have you been driving?

Can you drive a stick shift?

Yes

Will you drive your own car or will you require the use of a family car?

Own Car

Family Car

If using your own car, what is the:

Year:

Make:

Model:

What is your driver's license #:

Exp. Date:

MM slash DD slash YYYY

State license is issued in:

In the last 5 years have you had a license issued in another state?

Yes

If yes, what state(s):

Do you have any speeding tickets, any other motor vehicle violations, been in a car accident that you received a ticket for, or had you license suspended?

Yes

If yes, tell us about it:

Personal Background:

Have you ever been arrested found guilty for a crime?

Yes

If yes, tell us about it:

What are your future goals professionally?

What are your future goals personally?

Besides a nanny opportunity are there any other jobs you are currently pursuing?

What are your hobbies and interests?

Do you speak a foreign language?

Yes

If yes, which one(s):

Do you have any visible tattoos or piercings?

Yes

Do you swim?

Yes

Do you cook?

Yes

If yes, tell us about your level and desire to cook:

Did you experience any form of neglect of abuse as a child?

Yes

If yes, please explain:

What did you enjoy most about your parents' parenting skills?

What are your personal strengths?

What are your personal weaknesses?

Education:

1. Highschool

School:

Location:

Yrs Attnd

Date Graduated:

Degree:

2. College

School:

Location:

List

Yrs Attnd:

Date Graduated:

Degree:

3. Other

School:

Location:

Yrs Attnd:

Date Graduated:

Degree:

Major(s) Studied:

List any extra- curricular activites in highschool and/or college:

Are you currently attending college?

Yes

Nanny Experience:

Tell us about any early education classes or experiences that you have had:

Have you been a nanny before?

Yes

If yes, how many times?

Are you CPR or First Aid certified?

Yes

If not, are you willing to be?

Yes

If yes, can you provide proof?

Yes

Childcare Experience (start with present or last position):

Childcare Experience #1

From:

To:

Family or Organization:

Length of time/frequency:

Ages of children:

Address:

Home Telephone #:

Work Telephone #:

Childcare Experience #2

From:

To:

Family or Organization:

Length of time/frequency:

Ages of children:

Address:

Home Telephone #:

Work Telephone #:

Childcare Experience #3

From:

To:

Family or Organization:

Length of time/frequency:

Ages of children:

Address:

Home Telephone #:

Work Telephone #:

Childcare Experience #4

From:

To:

Family or Organization:

Length of time/frequency:

Ages of children:

Address:

Home Telephone #:

Work Telephone #:

Other Employment:

Other Employment #1:

From:

To:

Employer:

Job Description:

Supervisor:

First Last

Phone:

Other Employment #2:

From:

To:

Employer:

Job Description:

Supervisor:

First Last

Phone:

Other Employment #3:

From:

To:

Employer:

Job Description:

Supervisor:

First Last

Phone:

Other References (other then child care, friends, or relatives):

Reference #1:

Name:

Relationship To You:

Home Phone:

Work Phone:

Reference #2:

Name:

Relationship To You:

Home Phone:

Work Phone:

Reference #3:

Name:

Relationship To You:

Home Phone:

Work Phone:

I agree that all of the information on this application is true to the best of my knowledge.

I CERTIFY THAT THE ANSWERS GIVEN HEREIN AND THE INFORMATION PROVIDED ARE FACTUAL, TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT FALSIFICATIONS, OMISSIONS OR MISREPRESENTATIONS MAY BE CAUSE FOR REJECTION OF MY APPLICATION TO Nanny Nexus LLC. OR ANY OF ITS CLIENTS, AND IF EMPLOYED BY A CLIENT OF NANNY NEXUS LLC. MAY BE CAUSE FOR IMMEDIATE DISMISSAL IF DISCOVERED AFTER MY EMPLOYMENT. I AUTHORIZE INVESTIGATION OF ALL INFORMATION CONTAINED IN THIS APPLICATION AND ANY SUPPLEMENTAL MATERIAL SUPPLIED BY ME AS MAY BE NECESSARY. I FURTHER AUTHORIZE ANY EMPLOYER, PERSON, CORPORATION, OR EDUCATIONAL INSTITUTION LISTED HEREIN, INCLUDING NANNY NEXUS LLC, TO ANSWER ANY AND ALL QUESTIONS AND AGREE TO HOLD ALL PERSONS HARMLESS FOR PROVIDING ANY AND ALL INFORMATION WITHIN THEIR KNOWLEDGE OR RECORDS.

Electronic Signature: By selecting submit, you hereby verify that the above information is accurate. If not, please select cancel.

Nanny Application - FL

Placement Preferences

Driving Background:

Personal Background:

Education:

Nanny Experience:

Childcare Experience (start with present or last position):

Other Employment:

Other References (other then child care, friends, or relatives):

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