Full-Time, Live-In
Full-Time, Live-Out
Part-Time
Latch-Key, After School
Summer

I would like a job in: Roswell AlpharettaDunwoodySandy Springs  any other location

Full Name:

Present Phone: Best Time to Call:

Alternate Phone No. Beeper/Cell No.

Social Security No. Birth Date:

Present Address:

Former Address:

Are you a U.S. citizen? YesNo
If No, please provide evidence of status:

Are you currently employed? YesNo
If yes, where (company name, address, phone)?

Education:

High School:

College:

Other:

Major Field of Study:

Experience:

Briefly outline your experience in the following:

Childcare Experience:

Housekeeping Experience:

Will you do light housekeeping? Yes No

Will you cook for the children? Yes No

Work Experience Detailed

Please provide complete details of your work experience. Start with
your latest position and go back from there. If there are any gaps in
employment, please explain why.

From: To:
Employer Name:

Phone No:

Job Description (If childcare related, include age of children when you first started):

Supervisor's Name:

Reason left:

From: To:
Employer Name:

Phone No:

Job Description (If childcare related, include age of children when you first started):

Supervisor's Name:

Reason left:

From: To:
Employer Name:

Phone No:

Job Description (If childcare related, include age of children when you first started):

Supervisor's Name:

Reason left:

From: To:
Employer Name:

Phone No:

Job Description (If childcare related, include age of children when you first started):

Supervisor's Name:

Reason left:

From: To:
Employer Name:

Phone No:

Job Description (If childcare related, include age of children when you first started):

Supervisor's Name:

Reason left:

Additional Explanation for any of above:

References:

Please list 3 or more references. At least one must relate to recent childcare work.

Name, Address, Phone No., Relationship to you:

Reference 1:

Reference 2:

Reference 3:

Reference 4:

General Information:

Have you ever been convicted of a crime? YesNo
If yes, please explain:

Do you have a valid driver's license? Yes No
License No. State:

Are you allergic to any animals? Yes No
If yes, which animals:

Would you work in a home with pets? Yes No

Do you swim? Yes No
If yes, how well: Excellent Swimmer Very Good Swimmer Good Swimmer Fair Swimmer Poor Swimmer

Do you smoke? Yes No
If yes, how much?
and can you agree not to smoke on the job? Yes No

How often do you drink alcohol?

Are you taking any medication that interferes with your mental/physical functions? Yes No

New Job Information:

Is there any special area of town you want to work in?

Would you be willing to commit to a nanny position for at least one year?
Yes No

How many hours a week would you like to work?

What age child do you feel most comfortable with?

How many children are you comfortable caring for at one time?

Briefly describe the worst childcare situation you have ever been in and
how you handled it:

What are your strengths?

What are your weaknesses?

Would you prefer to work for a: Conservative Family Outgoing Family Doesn't Matter

What are your hobbies:

Please add any additional information you would like to tell us
about yourself:

ALL INFORMATION THAT I HAVE GIVEN IN THIS APPLICATION
IS TRUE IN ALL RESPECTS. I UNDERSTAND THAT THE EMPLOYER WILL
RELY ON THIS INFORMATION WHEN HIRING ME. IF ANY PART OF THIS
APPLICATION IS FOUND TO BE FALSE CONCERNING MYSELF, I MAY BE
IMMEDIATELY DISMISSED WITHOUT FURTHER OBLIGATION ON THE
PART OF MY EMPLOYER AND/OR CARING NANNIES. I UNDERSTAND
THAT CARING NANNIES IS NOT LIABLE OR RESPONSIBLE FOR ANY ACT
INITIATED BY MYSELF, THE EMPLOYEE, OR THE EMPLOYER. I AGREE TO
NOT HOLD CARING NANNIES RESPONSIBLE FOR ANY AND ALL CLAIMS,
INCLUDING ATTORNEY FEES AND COURT COSTS, INCURRED BY ANY
PERSON ARISING OUT OF MY EMPLOYMENT.

Signature of Applicant:
Email Address:

Date:

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