Above & Beyond Nannies, Inc.

Application For Nannies Seeking Employment

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Please Answer All Applicable Fields

Full Name:

Street Address (Line 1): Apt #:

Street Address (Line 2):

City: State: Zip:

E-Mail:(you@domain.net)

Home Phone #:()-Office Phone #()- ext#

1. What Sort of Position Are You Seeking?

Full Time | Part Time

2. Are You Seeking A Live-in Position?

Yes | No

-2a If not, why?

3. Can You Commit At Least One Year?

Yes | No

4. Date Available For Work:

January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

5. Hours Available For Work: (Check all that apply)

Mornings | Days | Evenings | Nights

.6. Health:

Poor | Fair | Good | Excellent

7. Do You Smoke?

Yes | No

If yes how much?

8. Do You Take Prescription Medications On A Regular Basis?

Yes | No

If yes how much?

9. Do You Have Any Allergies?

Yes | No

10. Can You Drive?

Yes | No

11. Is Your Drivers License Valid?

Yes | No

12. Do You Have Reliable Transportation?

Yes | No

-12a. If yes, do you have automobile insurance?

Yes | No

And who is your insurance provider?

13. Have You Ever Been Treated For Alcoholism or Drug Abuse?

Yes | No

-13a If yes how many times?

-13b Are you in recovery from drug or alcohol abuse?

Yes | No

-13c If yes for how long have you been in recovery?

months | years

14. Describe Any Accidents Or Moving Violations That May Appear On Your Driver's License Record.

15. Do You Have A Police Record?

Yes | No

-15a If yes briefly describe your criminal history.

16. Are You A United States Citizen or National?

Yes | No

-16a If no, do you have a visa?

Yes | No

-16b If yes, what type of visa do you have?

17. What Is The Make And Model Of Your Car?

Make | Model

Please Specify The Duties You Are willing to undertake by selecting yes | no | maybe:

18. Child Care For Stay-at-home Parent:

yes | no | maybe

19. Child Care For Single Parent:

yes | no | maybe

20. Cooking For Children:

yes | no | maybe

21. Housekeeping Related To Children's Care:

yes | no | maybe

22. Cooking For Family:

yes | no | maybe

23. Housekeeping For Family:

yes | no | maybe

24. Child-related Tasks Only:

yes | no | maybe

25. Do You Like Cleaning?

yes | no | maybe

26. Do You Like Cooking?

yes | no | maybe

27. Do You Like Household Pets?

yes | no | maybe

28. Please List Your Education Background.

	School Attended	Degree	Major	Years Attended
High School
College
Special Certification

29. Please Provide Your Childcare Experience & Length Of Experience:

	(Length of Experience)
Infants
Toddlers
Preschoolers
School Age
Special Needs
Overnight Care
Camp Counselor
Mentor Programs

30. Do You Speak Any Foreign Language?

yes | no

-30a If yes, please name any languages you speak:

31. Are You An Experienced Swimmer.

yes | no

32. Do You Feel Comfortable Swimming With Children?

yes | no

33. Please List Your Job Experience: (most recent first)

Employer & Job Title

Dates of

Phone Number

Reason For Leaving

34. Please List Any References You May Have Here:

Reference

Relationship

Phone Number

35. Please Write A Brief Summary Of What Would Make You A Great Nanny:

I attest that all the information provided is true.

yes no --

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