nanny boutique ‘the trust you require, the quality you desire’

nanny application

Please use this form to apply for inclusion in our nanny referral service.
Required fields are marked with a *

today's date:
May 26, 2018

name:*

have you gone by a different name than the one mentioned above?

address:*

city:*

state:*

zip:*

phone number (h):*

phone number (c):*

email address:*

emergency contact name:

emergency contact phone:

date of birth:

nationality:

how long have you lived in the U.S.?

have you lived in any other country/state in the last three years?
  Yes
  No

do you have a social security number?
  Yes
  No

do you have a green card or working visa?
  Yes
  No

do you have a valid driver's license?
  Yes
  No

other than English, list any languages that you speak:

highest level of education:
  High School Diploma
  Some College
  College Two-Year Degree
  College Four-Year Degree

any courses in childhood education and development?

Most families seek a nanny who is able to make a one year commitment. At the time you are ready to start working as a nanny, will you be able to make a 1 year commitment?
  Yes
  No

Job Specific Information

position applying for:
  Live In
  Live Out

  Part Time
  Full Time

when can you start work?

earliest start time:

latest end time:

working days sought:
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday
specific comments:

working hours sought:
specific comments:

do you have a car?
  Yes
  No

In what capacity of childcare do you have experience in?
(Live out nanny, live in nanny, relatives, camp counselor, preschool teacher, teacher, church nursery, day care center, etc...)

how many years of experience do you have?

what age of children do you have experience caring for?

have you ever had experience with children with special needs, handicaps?
  Yes
  No

what is the maximum number of children, regularly part of household, you a willing to care for?

Are you experienced and willing to help with the following household chores should they become part of your job description?
(General Housekeeping, preparing family meals, grocery shopping, laundry, ironing, running errands, etc)
  Yes
  No

are you a parent?
  Yes
  No

how would you rate your overall health?

please complete this sentence: "I am..."

what are your hobbies and interests?

please list any physical or psychological problems you have/have had in the past:

are you First Aid certified?
  Yes
  No

are you CPR certified?
  Yes
  No

if you are not First Aid and CPR certified, are you willing to become certified?
  Yes
  No

do you know how to swim?
  Yes
  No

do you smoke?
  Yes
  No

do you drink?
  Yes
  No

Have you ever had a substance abuse problem? If yes, how long ago?

have you ever been convicted of a crime, felony or misdemeanor?
  Yes
  No

are you comfortable working with a family who has pets?
  Yes
  No

$ to $ per week to start. Salary negotiable?
  Firm
  Negotiable

Reference Information

Give names and complete mailing addresses of at least three families you have baby-sat or nannied for:

Family #1

name:

address:

city:

state:

phone number:

how long did you work for this family?

how many children did you care for?

what were their ages when you began?

Family #2

name:

address:

city:

state:

phone number:

how long did you work for this family?

how many children did you care for?

what were their ages when you began?

Family #3

name:

address:

city:

state:

phone number:

how long did you work for this family?

how many children did you care for?

what were their ages when you began?

For more information please email us at: info@nannyboutique.com
Disclaimer/Terms of Use
© 2018 Nanny Boutique Inc.
May 26, 2018