2008 Nanny Application with Background Verification and Consent

BEFORE YOU START:

  1. If you feel you meet or exceed our minimum requirements, please complete the application. We look forward to working with you!
  2. Give yourself at least 45 minutes to fill out your application. To avoid having your session timeout while working on this form, we recommend that applicants work offline. Select "Work Offline" from the FILE menu.
  3. Please answer every question thoroughly, as we cannot process incomplete applications. The more detail you give us about yourself, the better the prospective families will feel they know you before calling you.
  4. The references and phone numbers are one of the most important parts of your application, so be sure to include updated, current numbers.
  5. Fields with an asterisk are required.
  6. Press the ENTER key only after the form is completed. Important: press the ENTER key once only.
  7. After submitting your application, call the office for an interview at 480-945-1109.
  8. Thank you for considering Caring Nannies. We look forward to helping you find a rewarding career!

Email
E-mail Address: *
How did you find us?
I found you through:

 Name of referring person:

 Locality of referring phone book or keywords used:
 
Placement Criteria
Date Available
 Days/Hours Available
 Desired Salary
Check all that apply:
  First Aid 
 CPR  		  Full-time 
 Part-time		  Live In 
 Live Out

Are you available on a regular basis for temporary jobs?   Yes    No
Personal Information
Last Name *
 First Name *
 Middle Initial *
Major Crossroads *
 Street
City
 State
 Zip
Home Phone *
 Day Phone *
 Mobile Phone
Emergency Contact *
 Phone *
 Relationship to You *
Citizenship. It is mandatory that you can prove your ability to work in the US.*  
If Other, Please Explain:
Education

Name City State Subjects Yrs Enrolled Degree Earned? Degree
High School
College 1
College 2

Registrar's Office Phone Number for Last School Attended:

Are You Currently Attending College?
 What Are Your Days/Hours?
Describe Your Short and Long Term Goals.

Any Other Courses, Certificates, Seminars Related to Childcare.
Employment (Non-Child Care Related)
Employer City State Position Start End Reason for Leaving Phone
1.
2.
3.
4.
General Information
We require a minimum of one year committment. Are you able to committ to one year?   Yes    No

Do You Have Any Physical Conditions That Will Affect Your Job Performance?
Do You Smoke?   Yes    No
Would You Have a Problem Lifting Babies or Children 50 lbs and Over?  
Please Explain:  
Is There Anything In Your Past Or Present Medical History You Would Like To Share, That Could Be Pertinent To Your Care Of A Child?  
If Yes, Please Explain:  
Do You Own Your Own Car?  What Year/Make? 
Do You Have Working Air Conditioning?    How Many Seat Belts? 
Describe Your Driving Record: 
Do You Swim Well Enough to Save a Drowning Child?  
With Whom do You Live? 
Who Would Care For Your Children When They Are Sick? 
How Do You Feel About Pets?
Do You Have Pet Allergies?
Describe Your Housekeeping Style?
Do You Enjoy Cooking? 

Describe
List Any Foreign Languages You Speak Fluently.

Do You Have Any Special Skills or Talents?

Describe Your Philosophy of Disciplining Children.

Check All Age Groups You Have Cared For:
 Newborn  Toddler  School-Aged  Infant  Preschool
With What Ages Are You Most Comfortable?
 Newborn  Toddler  School-Aged  Infant  Preschool
Do You Have Twins Experience? If so What Age? 
Are You Comfortable If A Parent Has A Home Office?
Are You Available to Travel With A Family?
What Skills Do You Possess That Will Make You a Good Caregiver?
How Would You Best Describe Yourself? How Do You Like to Spend Your Free Time?
Describe Your Family Background, Where You Grew Up, What Your Family Was Like, Your Child Care Experience, and What is Most Important to You.
Why Do You Want To Be A Nanny?

Skills

Select all you are willing to do:

 Child Care
 Errands
 Grocery Shopping
 Ironing
 Cooking
 Laundry
 Floors
 Cleaning
 Managing Others


Child Care Experience
Reference Name
 Home Phone
 Work Phone
 Best Time to Call
Position Held
 Dates of Employment
 Hours
Starting Salary
 Ending Salary
How Many Children Did You Care For? Initial Ages of Children
Did You Perform Any Housekeeping?
Did You Cook for the Family? Check All That Apply:
I cooked for children. I cooked for everyone. Breakfast Lunch Dinner
Length of Time With Family?
Reason for Leaving
Reference Name
 Home Phone
 Work Phone
 Best Time to Call
Position Held
 Dates of Employment
 Hours
Starting Salary
 Ending Salary
How Many Children Did You Care For? Initial Ages of Children
Did You Perform Any Housekeeping?
Did You Cook for the Family? Check All That Apply:
I cooked for children. I cooked for everyone. Breakfast Lunch Dinner
Length of Time With Family?
Reason for Leaving
Reference Name
 Home Phone
 Work Phone
 Best Time to Call
Position Held
 Dates of Employment
 Hours
Starting Salary
 Ending Salary
How Many Children Did You Care For? Initial Ages of Children
Did You Perform Any Housekeeping?
Did You Cook for the Family? Check All That Apply:
I cooked for children. I cooked for everyone. Breakfast Lunch Dinner
Length of Time With Family?
Reason for Leaving
Reference Name
 Home Phone
 Work Phone
 Best Time to Call
Position Held
 Dates of Employment
 Hours
Starting Salary
 Ending Salary
How Many Children Did You Care For? Initial Ages of Children
Did You Perform Any Housekeeping?
Did You Cook for the Family? Check All That Apply:
I cooked for children. I cooked for everyone. Breakfast Lunch Dinner
Length of Time With Family?
Reason for Leaving
Background Verification Consent & Release
Privacy Notice: For your protection, information from sensitive documents such as your Social Security and Drivers License numbers are not requested on this form. They will be required after your application is accepted and MUST be verified in order to complete your application.
Last Name *
 First Name*
 Middle Initial*
List All Previous Last Names Used:
Current Address*
Current City*
 Current State*
 Current Zip*
How Long at Above Address?
Previous Address
Previous Address
Previous Address
Vehicles You Own
 Year  Model  License Plate Number
Vehicle A
Vehicle B
Auto Issurer
  Policy Number  Expiration
How Many Years Have You Been Driving?  
How Long Have You Been Driving As Part of a Nanny Job?  

Do you have anything on your record for the past 5 years?*

Explain
Are You Willing To Take Psychological Screening?*
Agreement & Authorization

I certify that I have reviewed the forgoing information supplied by me, and it is true and correct to the best of my knowledge. In accordance with the Privacy Act, Freedom of Information Act, and the Fair Credit Reporting Act, I expressly authorize any person associated with any education institution, past or present employer, law enforcement agency or court to release this information to the background agency for the purpose of being considered for employment. I also authorize that a copy of this release be considered as an original. I hereby consent for CN to release all information collected in my application to prospective families.


I agree to not accept a position if the fee has not been paid. If a fee is unpaid, and I choose to remain in the position, I AGREE TO PAY THE REFERRAL FEE MYSELF.


If any Caring Nanny client offers a position to me with the intent of avoiding payment, I agree to report to Caring Nannies the same day. If I accept such a position, I agree to pay the appropriate fee to Caring Nannies in full.


I agree to not accept second-party referrals. If I accept a second party referral from a Caring Nannies Family, I AGREE TO PAY THE REFERRAL FEE MYSELF.


I agree not to refer friends or family members to any Caring Nannies client. If I do so, I agree to pay the appropriate fee to Caring Nannies in full.
I certify that the above information is true.*

You MUST File in Our Office Before Starting Your New Position:

First Aide and CPR certification: mail or fax in a copy of the front and back of your card. Call to sign up for classes. Classes are taught weekly in various locations around the valley.

Heartsavers 480-998-5193 HeartsaversInc.com
Emergency Response Team 623-561-0068

A five-year certified copy of your driving record from MVD. This will cost $3-$5.

A Personality Assessment can be taken online.
* Required
Revised: 4/8/2008