Quality Nanny Placements, LLC • Nanny Application

We are now hiring On-Call Caregivers Nationwide. If you are interested, please indicate that at the bottom of the application.

Please note - you can still apply for long-term placements if you are working with the On-Call department.

Contact Information

First & Last Name*

First NameLast Name

Address*

Street Address

Apartment #

CityState / Province

Postal / Zip Code

Main Contact Number*

Area CodePhone Number

Other Contact Number

Area CodePhone Number

Email Address*

Start Date

Date

Birth Date*

MonthDayYear

Do you have a driver license?*

YesNo

Driver's License Number

This is for your required driving record check

Do you own a vehicle?

YesNo

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.*

Can you commit to working at least one year with a family? (permanent placements ONLY)*

YesNo

While you search for a long-term position, are you open to working in our Back-Up Care department doing on-call care? If Yes, someone will reach out directly to explain how it works.*

YesNo

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

YesNo

Do you speak any languages other than English?*

YesNo

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?*

YesNoOther

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

YesNo

Do you have paid experience working with infants?*

YesNo

Do you have experience working with special needs children?*

YesNo

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*

YesNoExpired

Expiration Date

Month/Year

First Aid Certified*

YesNoExpired

Expiration Date

Month/Year

Education History:

Highschool*

Name

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 NameLast Name

Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Employer's Contact Number*

Area CodePhone 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

List any responsibilities that you had*

Reason for leaving*

May we contact this employer as a reference check?*

YesNo

Employer 2:

Employer's Name

First NameLast Name

Employer's Address

Street Address

Street Address Line 2

CityState / Province

Employer's Contact Number

Area CodePhone 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

List any responsibilities that you had

Reason for leaving

May we contact this employer as a reference check?

YesNo

Employer 3:

Employer's Name

First NameLast Name

Employer's Address

Street Address

Street Address Line 2

CityState / Province

Employer's Contact Number

Area CodePhone 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

List any responsibilities that you had

Reason for leaving

May we contact this employer as a reference check?

YesNo

What hourly rate do you charge?

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

Are you interested in doing On Call work for the agency while you are searching for a long term position?*

YesNo

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

YesNo

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

YesNo

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*

YesNo

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