Employment Application


Name
Social Security No.
Date of Birth
Email Address *REQUIRED*

Present Address
City
State
Zip
(If different from present)

Permanent Address
City
State
Zip

Home Telephone
Cell		Are you 18 years or older?
Yes No

Drivers License Number
State
Tag Number
State		Own Vehicle?
Yes No

 

Desired Employment

FT Nanny

 

PT Nanny less than 26 hours

 

 PT SitterStart Date

Days Available

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Are you currently employed? Yes No

If so may we inquire of your present employer? Yes No

Name of Supervisor

 

Education

School Level
Address
Number of Years
Did you Graduate?
Major

High School
Yes No
College
Yes No
Trade, Business or
Correspondence School
Yes No
Subjects of Special Study
Special Certified Training
Speak a second language? Yes NoLanguage
Hobbies or Special Interest Do you swim? Yes No
Comfortable with pets? Yes No

 

Former Employers (most recent first)


Name of Employer

Address
City
State
Zip

Start Date
End Date
Position

Starting Salary
Final Salary
May We Contact Employer? Yes No

Name of Supervisor
Telephone
Work Description
Reason for Leaving

Name of Employer

Address
City
State
Zip

Start Date
End Date
Position

Starting Salary
Final Salary
May We Contact Employer? Yes No

Name of Supervisor
Telephone
Work Description
Reason for Leaving

Name of Employer

Address
City
State
Zip

Start Date
End Date
Position

Starting Salary
Final Salary
May We Contact Employer? Yes No

Name of Supervisor
Telephone
Work Description
Reason for Leaving

 

Closest Relative


Name
Relationship

Address		 City
State
Zip

Telephone
Years Known

 

Personal References


Name
Title
Company or Association

Telephone
Years Known

Name
Title
Company or Association

Telephone
Years Known

Name
Title
Company or Association

Telephone
Years Known

 

 

Auto-Biography
Please write a brief auto-biography to help families learn more about you and why you should be considered for this position.

Please describe how you would handle the following hypothetical situations


A child that has difficulty waking up for school.


You find the child playing with a toxic chemical or an empty medication bottle


The children are fighting over sharing a toy


A child who won't eat his/her meal


What kind of indoor activities would you use to occupy a child?


A colic baby


An insubordinate child

 

Have you ever been convicted of a crime? Yes No


If yes, please explain

 

Electronic Authorization
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all sstatements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.


Full Name (E-Signature)..
Date


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