Login

Fillable Printable Blank Job Application Forms 02

Fillable Printable Blank Job Application Forms 02

Blank Job Application Forms 02

Blank Job Application Forms 02

VILLAGE NANNIES
APPLICATION FORM
DATE: ________________________________
GENERAL INFORMATION
Name:
Address:
Home Phone: Work Phone: Cell Phone:
Email Address:
Date of Birth: Social Security #/Social Insurance #:
DRIVING RECORD
Do you have a valid driver’s license? Yes No
License #: State/Province:
Number of accidents/moving violations in which you were a driver in the past 3 years: ___________
Explain:
Are you able to drive a manual transmission?
Yes No
Do you have your own car?
Yes No
MISCELLANEOUS
Have you ever been convicted of a crime? Yes No
If Yes, explain:
Do you smoke?
Yes No
Do you take drugs?
Yes No
Do you drink alcoholic
beverages? Yes No
MEDICAL HISTORY
Do you have any dietary restrictions? Yes No
If Yes, explain:
Do you have any medical conditions that may affect your ability to work as a nanny? Yes No
If Yes, explain:
What is your energy level? Are you physically able to work as a nanny?
Yes No
- 2 -
Do you have any allergies? Yes No
If Yes, explain:
Do you take any prescription medications?
Yes No
If Yes, list:
Have you had or do you currently have any psychological problems? Yes No
If Yes, explain:
EDUCATION
What is your highest level of education? School/College/University:
Do you have First Aid/CPR certification? Yes No
If Yes, what level? ____________________________________________________
Have you taken any additional courses or training? Yes No
If Yes, list:
INTERESTS
Hobbies: Sports:
Do you like pets? Yes No
Explain:
Do you do housekeeping?
Yes No
Explain:
Do you cook? Yes No
Explain:
List any other interests that may be relevant:
EMPLOYMENT HISTORY
Dates Employer Telephone Number Duties
NANNY EXPERIENCE
What is your previous nanny experience?
Live-in Nanny Live-out Nanny Mother’s Helper Other: __________________________
Describe your experience as a nanny/ mother’s helper/babysitter:
- 3 -
What is your previous experience working with children?
Teacher Teacher’s Aid Camp Counselor Babysitter Raised your own children
Other: ___________________________________________
- 4 -
What skills have you employed as a nanny (check those that apply):
Cared for nursing baby Prepared formula
Gave solid foods to baby Gave medications
Provided 24 hour childcare
Helped toilet train a toddler Taught child to swim
Cared for sick child (Explain: ________________________________________________________________)
Other:
Have you worked with special needs children? Yes No
If Yes, explain:
What is your experience working with children of different ages?
Newborn How Long: ____________ Explain: _____________________________________
6-24 months How Long: ___________ Explain: _____________________________________
2-5 years How Long: ___________ Explain: _____________________________________
6-12 years How Long: ___________ Explain: _____________________________________
Teenagers How Long: ___________ Explain: _____________________________________
REFERENCES
Please provide a personal reference (not a relative) who has known you at least 3 years:
Name: _________________________________________
Relationship: ___________________________________
Phone No: ______________________________________
CHILDCARE REFERENCES
Dates Worked Name Phone Number Ages of Children
- 5 -
Authorization
I, ____________________________________ [insert name of nanny], acknowledge that
_____________________________ [insert name of agency] (the “Agency”) may request a reference check,
which may include information on my character, general reputation, education, personal characteristics,
driving record, police record, and past employment. I hereby authorize the Agency to obtain any such
information.
I acknowledge that I have read and understand this statement and that, to the best of my knowledge, the
information provided in this application is true and correct.
I agree to release and hold the Agency harmless for any act of the employer. I also agree to hold the
Agency harmless of any claim as a result of any placement in which I am a part.
______________________________________________
Applicant’s Signature
______________________________________________
Date
Login to HandyPDF
Tips: Editig or filling the file you need via PC is much more easier!
By logging in, you indicate that you have read and agree our Terms and Privacy Policy.