Name
*
First Name
Last Name
Phone
*
(###)
###
####
Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Prior Address 1
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Prior Address 2
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Birthday
*
MM
DD
YYYY
Are you authorized to work in the U.S.?
*
Yes
No
Do you have 3 or more years of recent childcare experience?
*
Yes
No
Available to start work:
*
MM
DD
YYYY
Seeking what type of position:
*
(check all that apply)
What days / times are you available to work?
*
Desired hourly pay:
*
Is there an age group you prefer to work with?
*
Is there an age group you are NOT willing to work with?
*
Which job duties are you willing to complete?
(Check all that apply)
Highest level of education completed:
*
High School or GED
Some College
College Degree
Masters Degree
List school names, city, state, graduation date, and major/minor
*
Other than English, which languages do you speak?
How many years of childcare experience do you have?
*
Do you have experience with infants?
*
Yes
No
Why are you currently looking for a job?
*
Have you every been fired from a childcare job?
*
Yes
No
If yes, please explain:
Are you currently certified in infant and child CPR?
*
Yes
No
Are you currently certified in First Aid?
*
Yes
No
Do you have a clean criminal record?
*
Yes
No
If no, please explain:
What makes you a good nanny?
*
What is your nanny style?
*
What form of discipline do you find to be most effective?
*
How are you handling COVID-19?
*
(i.e., do you wear a mask, how often do you leave the house, who do you live with)
Type of Position/Title 1
*
Description 1
*
(include dates of employment, ages of children, salary and responsibilities)
Reference Name 1
*
Reference Phone Number 1
*
(###)
###
####
Reference Email 1
Type of Position/Title 2
Description 2
(include dates of employment, ages of children, salary and responsibilities)
Reference Name 2
Reference Phone Number 2
(###)
###
####
Reference Email 2
Type of Position/Title 3
Description 3
(include dates of employment, ages of children, salary and responsibilities)
Reference Name 3
Reference Phone Number 3
(###)
###
####
Reference Email 3
Do you have a valid CA Driver's License?
*
Yes
No
Do you have full coverage auto insurance?
*
Yes
No
Provide make, model and year of car you will drive at work:
*
Have you had any at fault accidents or speeding tickets in the last 3 years?
*
Yes
No
If yes, please explain:
