Fill out this form to apply to be a nanny.

Please fill out all information to the best of your knowledge.

MAKE SURE YOU ANSWER EVERY QUESTION THAT HAS A RED * ASTERISK TO THE RIGHT OF IT. THANK YOU.

Name * First Middle Last
Cell Number * ### - ### - ####
Home Number ### - ### - ####
Email *
Best Time To Reach You. *
AM Noon PM
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Number of years at current residence. *
Permanent Address (If applicable) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Background Information

The following information is required for use in background checks, to be done by the Minnesota Criminal Bureau of Apprehension, therefore allowing full discloser on all criminal history to date.
Date of Birth * MM / DD / YYYY
Marital Status *
Maiden Name *
Social Security# *

Do not include any dashes.
Drivers License # *
State Issued *
Please select the box below if you agree to the following statement.

I voluntarily give my permission to Erin Hammill, the representative of Above & Beyond Nannies, to do a criminal and driving history background checks and life history checks so that I may become a Referral Candidate.
Please select the button below if you agree to the statement above. *
I Agree to the statement above.
NANNY POSITION INFORMATION
What type of employment are you seeking? *
Full Time Part Time
Are you seeking a live-in position? *
Yes No
Can you make a one year commitment to a family? *
Yes No
Date available for work? * MM / DD / YYYY
Please list hours available for work
Sunday AM-PM *
Monday AM-PM *
Tuesday AM-PM *
Wednesday AM-PM *
Thursday AM-PM *
Friday AM-PM *
Saturday AM-PM *
How would you rate your health? *
Excellent Good Fair Poor
Do you smoke? *
Yes No
Do you take prescription medications on a regular basis? *
Yes No
Any allergies? If yes, to what? *
No Yes
Do you have a valid drivers license? *
Yes No
Do you have reliable transportation? *
Yes No
If yes, do you have automobile insurance? With whom?
No Yes
Describe any accidents or moving violations that may appear on your driver’s license record.
What is the Make / Model of your car?
Have you ever been treated for alcoholism or drug abuse? *
No Yes
If yes, how many times? Are you in recovery?
Do you have a police record? *
No Yes
If yes, what is your criminal history?
Are you a United States citizen? *
No Yes
If not, do you have a visa? And what type?
Duties

Please respond yes / no / maybe to duties you would be willing to undertake: Please explain any “no” or “maybe” answers.
Child care for stay at home parent? *
Yes No Maybe
Child care for single parent? *
Yes No Maybe
Cooking for children? *
Yes No Maybe
Housekeeping related to children's care? *
Yes No Maybe
Cooking for family? *
Yes No Maybe
Housekeeping for family? *
Yes No Maybe
Child-related tasks only? *
Yes No Maybe
Do you like cleaning? *
Yes No Maybe
Do you like cooking? *
Yes No Maybe
Do you like household pets? *
Yes No Maybe
Do you have any children of your own? *
Yes No Maybe
If yes, would you need to bring them along? to a nanny position?
*
Yes No
If yes what are their ages?
Do you speak any second languages? If so, which languages? *
No Yes
Are you an experienced swimmer? *
Yes No
If Yes, do you feel comfortable swimming with children? *
Yes No
Education Background
High School *
Did you receive your diploma? *
Yes No
College
Degree
Major
Years Attended
Do you have any special certification? Please List.
Child Care Experience

Please provide your childcare experience & length of experience?
Infants *

Number of years you have experience with infants.
Toddlers *

Number of years you have experience with toddlers.
Preschoolers *

Number of years you have experience with preschoolers.
School Age *

Number of years you have experience with school age.
Special needs *

Number of years you have experience with special needs.
Overnight care *

Number of years you have experience with overnight care.
Camp Counselor *

Number of years you have experience with camp counselor.
Multiples *

Number of years you have experience with multiples.
How many miles are you willing to commute? *
10 20 30 40 Other
Previous Employer info

A description of the section goes here.
Employer & Job Title *
Dates *
Phone Number * ### - ### - ####
Reason For leaving *
Employer #2
Employer & Job Title
Dates
Phone Number ### - ### - ####
Reason For leaving
Employer #3
Employer & Job Title
Dates
Phone Number ### - ### - ####
Reason For leaving
Employer #4
Employer & Job Title
Dates
Phone Number ### - ### - ####
Reason For leaving
Employer #5
Employer & Job Title
Dates
Phone Number ### - ### - ####
Reason For leaving
References

Please provide Name, Relationship, Phone Number, and email address. Separate each section with a comma.
Reference 1 *
Reference 2 *
Reference 3 *
Reference 4 *
Reference 5 *
Please write a brief summary of what would make you a great nanny:
How would you describe your housekeeping standards? *
Meticulous Neat & Orderly Slightly Messy Average
Please check the six characteristics which best describe you. *
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 list three activities you would plan for Infants.

Separate each answer with a comma. Thank You
Please list three activities you would plan for Toddlers.

Separate each answer with a comma. Thank You
Please list three activities you would plan for Preschoolers.

Separate each answer with a comma. Thank You
Please list three activities you would plan for school age kids.

Separate each answer with a comma. Thank You
What is your energy level? *

Separate each answer with a comma. Thank You
What is your salary requirement per hour? * $ Dollars . Cents
What are your views on, and ways to discipline?
Do you have any medical conditions that would limit you in performing your tasks as a nanny? *
Please Confirm your information is true.
I attest that the information given on all forms presented to me today are true. *
I Agree
Please fill in your name followed by the date *

Name followed by 00/00/00

Fill out this form to apply to be a nanny.

Background Information

Please select the box below if you agree to the following statement.

NANNY POSITION INFORMATION

Please list hours available for work

Duties

Education Background

Child Care Experience

Previous Employer info

Employer #2

Employer #3

Employer #4

Employer #5

References

Please Confirm your information is true.