Quality Nanny Placements, LLC • Nanny Application

Please note that our agency requires a minimum of 3 years nanny experience in order to be considered for a position. If you do not meet this requirement, you will be denied. Some exceptions are made for candidates with related experience such as teachers and long-term daycare providers.

**We are now hiring for On-Call Caregivers in the following states:

New York
New Jersey
Connecticut
Iowa
Utah
Nevada
Delaware
Pennsylvania

Contact Information

First & Last Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Main Contact Number *

Area Code Phone Number

Other Contact Number

Area Code Phone Number

Is this your mobile number?

Yes No

Email Address *

Skype ID

Start Date

Date

Birth Date *

Month Day Year

Do you have a driver license? *

Yes No

Driver's License Number

This is for your required driving record check

Do you own a vehicle?

Yes No

If yes, what type of vehicle do you own?

Ex: Sedan, SUV, Van, Truck, Jeep, etc.

Please specify what type of position you are interested in applying for. *

Live-In Live-Out Full-Time Part-Time Any

Have you tested positive for COVID-19? *

Yes No I have NOT been tested

What precautionary measures do you take to protect yourself and others from COVID - 19?

Please leave as much detail as possible

Will you take a COVID-19 test if required before starting a Nanny job if the family asks? *

Yes No

Can you commit to working at least one year with a family? *

Yes No

Have you ever been arrested? *

Yes No

In the event of an emergency, are you able to swim? *

Yes No

Do you smoke? *

Yes No

Do you speak any languages other than English? *

Yes No

If yes, what other language(s) do you speak?

Are you physically able to climb stairs throughout the day and chase after small children without any difficulty? *

Yes No

Do you have children?

Yes No

Do you have reliable childcare for your children?

Yes No

If yes, what are their ages?

Do you have a minimum of 3 years paid experience working as a childcare provider? *

Yes No

Do you have paid experience working with infants? *

Yes No

Do you have experience working with special needs children? *

Yes No

If yes, please list any experience that you may have with special needs children.

I am: *

willing to work in a home with pets. able to prepare basic meals. able to travel with a family. available to work occasional overnights. comfortable working with infants. None of the above

CPR Certified *

Yes No Expired

Expiration Date

Month/Year

First Aid Certified *

Yes No Expired

Expiration Date

Month/Year

Education History:

Highschool *

Name

Did you graduate? *

Yes No

Date of Graduation *

Year

Did you attend College? *

College

Date of Graduation

Degree

Do you have additional Education to add?

College

Date of Graduation

Degree

Employment History:

Employer 1:

Employer's Name *

First Name Last Name

Employer's Address *

Street Address

Street Address Line 2

City State / Province

Employer's Contact Number *

Area Code Phone Number

Your Job Title *

Start Date *

Month/Year

End Date *

Month/Year

Number of Children *

Ages of children when you started *

ex: 4 years, 7 years

Salary

List any responsibilities that you had *

Reason for leaving *

May we contact this employer as a reference check? *

Yes No

Employer 2:

Employer's Name

First Name Last Name

Employer's Address

Street Address

Street Address Line 2

City State / Province

Employer's Contact Number

Area Code Phone Number

Your Job Title

Start Date

Month/Year

End Date

Month/Year

Number of Children

Ages of children when you started

ex: 4 years, 7 years

Salary

List any responsibilities that you had

Reason for leaving

May we contact this employer as a reference check?

Yes No

Employer 3:

Employer's Name

First Name Last Name

Employer's Address

Street Address

Street Address Line 2

City State / Province

Employer's Contact Number

Area Code Phone Number

Your Job Title

Start Date

Month/Year

End Date

Month/Year

Number of Children

Ages of children when you started

ex: 4 years, 7 years

Salary

List any responsibilities that you had

Reason for leaving

May we contact this employer as a reference check?

Yes No

Final Questions:

Please answer each question as best you can. The more detail involved, the better idea the families will have of you!

Briefly describe why you enjoy being a nanny *

Briefly, sum up what you have been doing for the last 3 years in your career *

List one positive memory that you have from working as a nanny *

Describe your beliefs about disciplining children *

Describe your personality *

Describe your hobbies and interests *

Describe your childhood and how you were raised *

Tell us what you think makes a great nanny *

List anything else that you would like the family to know about *

How did you hear about Quality Nanny Placements? *

Is there a particular listed position you are interested in? If so, please list the name of the town for that job: *

Town of position you are interested in

By checking the 'Yes' box below, you are verifying that you are legally authorized to work in the United States. *

Yes No

By checking the 'Yes' box below, you are verifying that you are agreeing to a background & driving record check. *

Yes No

By checking the 'Yes' box below, you are verifying that you are agreeing to commit to a minimum of one year with a family if you are placed *

Yes No

File Upload:

(This is NOT mandatory)

Photo

Upload a Photo

Limited to (2) photos; please make sure the photo is labeled as your name

Nanny Resume

Upload a File

Please make sure the file name is your first and last name

Please review your application and make sure that all of your information is correct before applying.

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Quality Nanny Placements, LLC • Nanny Application 2016