• Nanny Application Form

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• Date
• Name*
• Phone

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• Email
• 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
• 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.*
• 
  
• Signature
• 
  

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