Above & Beyond Nannies, Inc.

Application For Prospective Nannies

Please be as thorough as possible. empty form fields will be submitted as N/A or No Response
If you are unsure or have no response to a question, please complete the field by entering an appropriate "null" response

First Name:

Last Name:
Street Address:
City:    State:    Zip: Email:
Cell Phone Number: ( ) -

Home Phone Number:

 ( ) -
Length of residence: Marital Status:
Permanent Address (if applicable):
(Permanent) City:    State:    Zip:
What is the best time to reach you? Morning Noon Afternoon Evening
The following information is required for use in background checks, to be done by the Minnesota Criminal Bureau of Apprehension, therefore allowing full disclosure on all criminal history to date.
Maiden Name: Date of Birth:
Social Security No.: Driver's License: State:
Are you a US resident? Y N If not a citizen, what type of visa do you have (if any):
By typing your name in the following box, you are voluntarily giving permission to Erin Hammill, the representative of Above & Beyond Nannies, to do a criminal and driving history background checks so that you may become a Referral Candidate.
Digitally sign the above agreement by typing your full name in the following box:
BASIC BACKGROUND INFO
What type of employment are you seeking? FT or PT Are you seeking a live-in position? Y N
Can you make a 1-year commitment to a family? Y N Date Available:
Hours available for work:
DAY Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Time In
Time Out
How would you rate your health? Excellent Good Fair Poor
Do you smoke? Y N --   If yes, how much? Do you take prescription medication(s) regularly? Y N
Do you have allergies? Y N If yes, what are they?
Do you drive regularly? Y N Is your drivers license valid? Y N
Do you have reliable transportation? Y N Make, model, & yr of your car:
Who is your automobile insurance carrier?
Describe any accidents or other moving violations that may appear on your driving record:
Have you been treated for alcoholism or drug abuse/addiction? Y N
If yes, how many times? Are you currently in recovery? Y N
Do you have a criminal record? Y N
If yes, please detail . . .
Please list your job experience (in sequence - most recent on top):
Employer & Job Title Dates (MM-YY to MM-YY) Phone Number Reason for Leaving
Please use this space provided for your references:
Reference Relationship Phone Number Email Address
Please write a brief summary of what would make you a great nanny:

  - Characters Used (limit 1000)A value is ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ maximum number of characters.
Education: School Attended Degree Major Yrs. attended
High School   Graduated? Yes No
College
Special Certification
Please list your length of experience based on each of the following childcare experiences:
Infants: Toddlers: Preschoolers: School Age:
Special Needs: Overnight Care: Camp Counselor: Multiples:
DUTIES and DETAILS OF EMPLOYMENT
Please respond accordingly to duties you would be willing to undertake and explain any "NO" or "MAYBE" answers
Child care for stay-at-home parent?
YES NO MAYBE - EXPLAIN:
Child care for single parent?
YES NO MAYBE - EXPLAIN:
Cooking for Children?
YES NO MAYBE - EXPLAIN:
Housekeeping related to children's care?
YES NO MAYBE - EXPLAIN:
Cooking for family?
YES NO MAYBE - EXPLAIN:
Housekeeping for family?
YES NO MAYBE - EXPLAIN:
Child-related tasks only?
YES NO MAYBE - EXPLAIN:
Do you like cleaning?
YES NO MAYBE - EXPLAIN:
Do you like cooking?
YES NO MAYBE - EXPLAIN:
Do you like household pets?
YES NO MAYBE - EXPLAIN:
Do you have any children of your own? YES NO
If you have children of your own, would you need to bring them with you to your nanny position? YES NO
What are the ages of your children (if applicable)?
Do you speak any second languages? YES NO - if yes, please detail
Are you an experienced swimmer? YES NO
Are you comfortable swimming with children?
YES NO MAYBE - EXPLAIN:
How many miles are you willing to commute?
Please list three activities you would plan for EACH of the following age groups:
Infant Preschooler
Activity 1 Activity 1
Activity 2 Activity 2
Activity 3 Activity 3
Toddler School Age
Activity 1 Activity 1
Activity 2 Activity 2
Activity 3 Activity 3

How would you describe your housekeeping standards: Slightly Messy Average Neat and Orderly Meticulous
Please check six characteristics that best describe you (only 6):
Reserved Open-Minded Accommodating Adventurous High Energy
Enthusiastic Happy Patient Detail Oriented Confident
Friendly Strict Emotional Affectionate Organized
Outgoing Athletic Musical Intelligent Calm
Flexible Avoid Conflict Religious Nurturing  
Please describe what you have learned from your previous childcare positions:
To help us get to know you better . . . please give us a brief bio of your family background:
Please electronically sign this form by typing your full name in the following text field:

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