• Nanny Application Form

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• Date
• Name*
• Phone

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• Email
• Address

  Street Address 1

  Street Address 2

  City

  State/Province/Region

  Postal/Zip Code

  Country
• Date of Birth*
• Social Security Number*
• Driver License Number/State*
• Are you legally eligible to work in the U.S.?*

  Yes No
• If offered a position, are you willing to submit to a background check?*

  Yes No
• How many years of experience do you have working as a nanny?*
• Do you speak English fluently?*

  Yes No
• What other languages do you speak?* Select Arabic Chinese French Italian Spanish Other
• Do you have any health issues/restrictions which might impact the positions you are able to take? (For example, allergies, lifting, etc.)*
  Yes No

  If yes, please describe.
• Are you trained in CPR/First Aid?*

  Yes No
• Can you work in homes with pets?*

  Yes, pets are fine. No, I'd prefer not to work around pets.
• Do you have reliable transportation?*

  Yes No
• Are you interested in a live-in position, if available?*

  Yes No
• Are you able to travel with a family, if needed?*

  Yes No
• What days are you available to work?*

  Sunday Monday Tuesday Wednesday Thursday Friday Saturday
• Please provide contact info of families you've nannied for.

  Name	Phone#	Address

• Please tell us about yourself and your experience as a nanny.*
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• Signature
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