Nanny Employment Application
 
First Name
 *
Last Name
 *
 
Home Phone
 *
Cell # or Alt #
Email
 
Address
 *
City
 *
State
 *
Zip
 *
 
Birth Date
 *
Are you a US citizen?
 *
If NOT, are you eligible to work in the US?
Green card # or work permit #
 
Position Desired (Please check all that apply)
 
 
 
 
 
 
 
Hours you are available to work
 *
If looking for a permanent job, can you commit to a year?
 *
What are your salary requirements?
 *
What areas are you looking to nanny in?
 *
 
All of our placed nannies must have current CPR certification. We will give you ample time to get certified.
Are you CPR certified?
 *
Date of Certification
If not are you willing to get CPR certified if family requests it?
 
Have you ever been arrested, or convicted of a misdemeanor or a felony?
 *
If yes, please explain. (This will not necessarily exclude you from getting a job).
Do you have a valid driver’s license?
 *
Driver's license # & State
Do you have a car?
 *
Make & Model Year
License Plate #
State licensed in
 
Education
High School:
Name and address, date graduated
 *
College:
Name and address, Major, Dates Attended, Degree
 *
Other Education/Degrees:
Name and address, Dates attended, Degree
Are you currently attending?
 *
If so your schedule
Honors if any
 
Are you fluent in any other languages?
 *
Please list any volunteer work you have done
What are your long-term goals/dreams?
 *
What are your hobbies?
 *
 
Personal Information
Marital Status
Do you have any children?
 *
Ages
Who is your backup if they get sick?
Do you plan on bringing them to work with you?
Do you have any medical training?
 *
If yes please explain
Do you smoke?
 *
Do you know how to swim?
 *
Please describe any present or past health issues.
Please list any prescribed medications you take and their purpose
Do you have any restrictions on lifting?
 *
If yes, please describe
Do you have any objections to pets?
 *
Please list any allergies you may have
 
References
May we call your current or previous employers?
 *
If not, please explain why
 
Current or Last Child Care Employer
 *
Address, City, State, and Zip
 *
Contact Name
 *
Home or Cell #
 *
Email Address
Start Date
 *
End Date
 *
Did you care for children on this job?
 *
Ages of Children When Job Began
Live-in or Live-out and Hours worked/Days and or nights
 *
Job Description
 *
Salary
 *
Reason for Leaving
 *
Child Care Employer #2
 *
Address, City, State, and Zip
 *
Contact Name
 *
Home or Cell #
 *
Email Address
Start Date
 *
End Date
 *
Did you care for children on this job?
 *
Ages of Children When Job Began
Live-in or Live-out and Hours worked/Days and or nights
 *
Job Description
 *
Salary
 *
Reason for Leaving
 *
 
Employer #3
Address, City, State, and Zip
Contact Name
Home or Cell #
Email Address
Start Date
End Date
Did you care for children on this job?
Ages of Children When Job Began
Live-in or Live-out and Hours worked/Days and or nights
Job Description
Salary
Reason for Leaving
 
Names, phone numbers, dates, etc. of any additional CHILDCARE references
 *
Give name and phone numbers of 2 PERSONAL references not related to you
Please explain any gaps in employment over the last 5 years
 
Childcare Experience
Do you have any experience working with a special needs child?
 *
If yes, please explain
Have you cared for a nursing baby?
 *
Toilet trained a child?
 *
Taught a child to swim?
 *
What ages of children would you prefer to work with?
 *
How many children are you willing to care for?
 *
Would you consider caring for a child with special needs?
 *
Are you willing to travel with a family?
 *
Are you willing to prepare meals for the family?
 *
Are you willing to provide light household duties?
 *
What would be an age-appropriate activity that you might do with a 3-year-old?
 *
what age children do you have experience with
 *
How did you hear about Superior Nannies LLC?
 *
 
Emergency Contact Information
Emergency Contact
Address
Phone Number
Relationship
 
Application Certification
I certify that the facts contained in this application are true and complete to the best of my knowledge.
If I do not have current CPR certification, I agree to obtain it within the first 30 days of my employment.
In the event that Superior Nannies LLC does not receive its placement fee, I agree to discontinue working for the family if the agency asks me to do so.
 
 *
 
Please feel free to call Superior Nannies LLC with any questions at 303-725-5440
 
 
  PHONE 303.725.5440
SERVING: BOULDER, DENVER, LOUISVILLE
AND SURROUNDING COLORADO AREAS