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Nanny Info Form New Jersey

NANNY INFO FORM

Nanny Info Form

Name

Address:

Apt #:

City:

State:

Zip Code:

General Location:

Travel Radius:

Home Phone:

Cell Phone:

E-mail Address:

Do you Drive?

Yes

No

Do you Have your Own Car?

Yes

No

Make & Model:

How many car seats can you safely put in your car?

Driver's License #:

State of Driver's License:

Ages of Children You've Cared For:

Ages of Children You Would Prefer:

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Select those which apply.

(Y=YES, N=NO, D=DEPENDS, S=SOMETIMES)

Do You Smoke:

Y

N

D

S

Special Needs Care:

Y

N

D

S

Prepare Meals:

Y

N

D

S

Work Flexible Hours:

Y

N

D

S

Do Housework:

Y

N

D

S

Take Your Child with You:

Y

N

D

S

Do You Like Pets:

Y

N

D

S

Can You Swim

Y

N

D

S

Infant Experience:

Y

N

D

S

Care for the Elderly:

Y

N

D

S

Select the Types of Jobs You Are Interested In

Full Time

Part Time

Tutor Care

Summer

Evening

Weekend

Overnight

Specific Days and Hours Needed:

Select those that apply.

Attended High School

High School Graduate

Attended College

College Graduate

Advanced Degree

Nanny School Graduate

Languages Spoken:

Other Childcare Training:

Name of Highschool:

Dates Attended:

Location of High School:

Year Graduated:

Name of College:

Date Attended:

Location of College:

Year Graduated:

College Field of Study:

Degree Obtained:

Start Date:

End Date:

Salary Requested:

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List below anyone else you know that may be interested in being a nanny.

Name:

Phone #:

Name:

Phone #:

How long could you commit to a family?

How does a childcare job fit into your future?

Are you signed up with any other nanny services?

Yes

No

If yes, which ones, including other ACN offices?

Do you use alcohol, nicotine, or drugs?

Yes

No

If yes, please explain:

List any allergies that might affect your job:

Do you have any physical conditions that might affect your performance as a nanny?

Are you on medication?

Yes

No

If yes, please explain:

Can you obtain a letter of good health from a doctor or a clinic?

Have you ever been convicted of a crime?

Yes

No

If yes, explain the nature of the offense, date & court outcome:

Have you had any speeding tickets, moving violations, accidents, traffic convictions or points on your license within the last 10 years?

Yes

No

If yes, please explain:

Have you ever been dismissed from a job?

Yes

No

If yes, please note: Date:

Employer:

Are you certified in CPR?

Yes

No

If yes, when is the expiration date

Are you certified in First Aid?

Yes

No

If yes, when is the expiration date

Do you have multiples experience?

Yes

No

If yes, what type (twins, triplets, etc.), what age(s) and where was the experience from (day care, private home, etc):

Which of the following duties are you willing to do? Select those that apply.

Child's Laundry

Family Laundry

Tidy Living Area

Scrub Kitchen & Bath

Child's Meal Prep

Family Meal Prep

Light Vacuum/Dust

All Vacuum/Dust

Pet Care

Run Errands

Person To Contact In Case of Emergency:

Relationship to you:

Phone #:

Nearest Relative NOT Living With You:

Relationship to you:

Phone #:

Which job situation(s) would you feel comfortable with? Select those that apply

Multiples Experience

Multiple Children of Different Ages

Children with Special Needs or Problems

Parent(s) Working at Home

Infants or Newborns

Grandparents at Home

Two Families Sharing You

None of These Situations

How did you learn about A Choice Nanny?

Why do you want to become a nanny?

How did you get interested in childcare?

What qualities would make you a good nanny?

What do you feel children like best about you?

What forms of discipline do you use?

What methods of limit setting do you use?

What would you do to keep a toddler busy on a rainy day?

How would you handle a 2-year old's temper tantrum?

How would you handle a 4-year old who spilled their milk?

How would you handle an 8-year old that is being rude & unwilling to do what they are told?

What activities would you plan to do with children of various ages?

What do you believe makes a happy childhood?

What is the best job you have had and why?

Why should a parent hire you?

What kind of family would you like to work for?

What is the hardest or most difficult situation you have had to deal with in your life?

What have you done that you are most proud of in your life?

How do you resolve conflicts with others?

What do you like most about yourself?

If a parent comes home late every day, how would you handle it?

If a parent asks you for assistance with something that is not usually in your job description, what would you do?

If a parent tells you that you need to improve on some of your duties, how would you react?

If a parent treats you unfairly, from your point of view, how would you react and how would you handle that situation?

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MOST RECENT OR CURRENT EMPLOYMENT

COMPANY NAME:

ADDRESS:

SUITE #:

CITY:

STATE:

ZIP CODE:

PHONE #:

SUPERVISOR'S NAME:

JOB TITLE:

DATES OF EMPLOYMENT:

REASON FOR LEAVING:

Free Text Non Relative

NANNY CANDIDATE (NON-RELATIVE)

REFERENCE INFORMATION

Childcare References

NAME:

HIS/HER PROFESSION:

ADDRESS:

HOME PHONE:

WORK PHONE:

CELL PHONE:

E-MAIL:

RELATIONSHIP TO YOU:

DATES OF EMPLOYMENT:

AGES OF CHILDREN CARED FOR:

JOB RESPONSIBILITIES:

DATE AND REASON FOR LEAVING:

NAME:

HIS/HER PROFESSION:

ADDRESS:

HOME PHONE:

WORK PHONE:

CELL PHONE:

E-MAIL:

RELATIONSHIP TO YOU:

DATES OF EMPLOYMENT:

AGES OF CHILDREN CARED FOR:

JOB RESPONSIBILITES:

DATE AND REASON FOR LEAVING

NAME:

HIS/HER PROFESSION:

ADDRESS:

HOME PHONE:

WORK PHONE:

CELL PHONE:

E-MAIL:

RELATIONSHIP TO YOU:

DATES OF EMPLOYMENT:

AGES OF CHILDREN CARED FOR:

JOB RESPONSIBILITIES:

DATE AND REASON FOR LEAVING:

NAME:

HIS/HER PROFESSION:

ADDRESS:

HOME PHONE:

WORK PHONE:

CELL PHONE:

E-MAIL:

RELATIONSHIP TO YOU

DATES OF EMPLOYMENT:

AGES OF CHILDREN CARED FOR:

JOB RESPONSIBILITIES:

DATE AND REASON FOR LEAVING:

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Personal References

NAME:

HIS/HER PROFESSION:

ADDRESS:

WORK PHONE

WORK PHONE:

CELL PHONE:

E-MAIL:

RELATIONSHIP TO YOU:

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PREVIOUS EMPLOYMENT

(NON-CHILDCARE)

COMPANY NAME:

SUITE #:

CITY:

STATE:

ZIP CODE:

PHONE #:

SUPERVISOR'S NAME:

JOB TITLE:

DATES OF EMPLOYMENT:

REASON FOR LEAVING:

COMPANY NAME:

SUITE #:

CITY:

STATE:

ZIP CODE:

PHONE #:

SUPERVISOR'S NAME:

JOB TITLE:

DATES OF EMPLOYMENT:

REASON FOR LEAVING:

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Once you've submitted this information, you will receive an email that will include the final portion of your application via docusign.

Thank you for contacting us.
We will get back to you as soon as possible.

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Home
About Us
Locations
- New Jersey & Rockland County, NY
Families
Nannies
Full Service vs. Online

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