Nanny Application - Preferred Child Care

Application

Date Applying

First Name

Last Name

Cell Phone

Home Address

Apt, suite, etc.

Country

City

State

Zip code

Years at Current Address

Do you have a valid Drivers License?

Yes

Do you have a car?

Yes

Have you had any accidents or driving violations?

Yes

If yes, please explain below.

High School Name

Did you graduate High School?

Yes

GED

Did or do you attend college and if so, please list the college's name?

What year did you or do you anticipate graduating?

Type of degree you are pursuing?

Major/Minor desired.

Current GPA

How many years of experience do you have working with children in any capacity?

If Other, please explain below.

If you speak a Foreign Language, which one?

Are you fluent?

Yes

Date Available to Start

How long are you willing to commit?

How many hours do you desire per week?

Please describe any scheduling limitations or considerations for the next 12 months. Include current work and/or school schedules.

Please briefly describe some personal interests and hobbies you have.

Please briefly describe the type of caregiver you consider yourself to be.

Ex: Lenient, structured, etc...

How did you hear about Preferred ChildCare, Inc.?

As a part of our service to our families, we will conduct a criminal background check, a motor vehicle report history, a social security trace, and a sexual offenders check. Do you give us permission to run these checks?

Yes

By signing below, you certify that these statements are accurate and true. If you are hired by Preferred Childcare, Inc. as a ChildCare Specialist, you agree to notify Preferred Childcare, Inc. if any changes to your contact information are made.

Electronic Signature

Today\'s Date

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