Become a Nanny - Nanny Application Form Name * First Name Last Name Address * Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Phone Number * - Area Code Phone Number Email * example@example.com What type of position are you looking? * Full-time Part-time on-call What type of nanny position are you looking for? * Live-in Live-out Preferred start date * - Month - Day Year Date Date Picker Icon Weekly desired salary (before tax) * Are you able to make a one year commitment? * Yes No Are you legally able to work in the U.S? * Yes No Do you own a car? * Yes No Have you ever had a DUI, moving violations, tickets, or accidents in the last 10 years? * Yes No If yes, please explain in detail each incident Do you smoke? * Yes No Are you comfortable with pets? * Yes No If no, please explain reasoning (allergies, afraid, etc) Are you currently CPR certified or willing to get certified? * Yes No Are you currently First Aid certified or willing to get certified? * Yes No Do you swim? * Yes No Did you graduate high school? * yes no Graduation Year * Please list ALL colleges attended and how many years Did you graduate college? * Yes No Degree Obtained if applicable Employer #1 * Employer #1 Phone * - Area Code Phone Number Employer #1 start and end dates * Employer #1 position held * Employer #1 names/ages of children * Employer #1: Can we use this employer as a reference? * Yes No Employer #1 hours * Employer #1 - was this position full-time or part-time? * Yes No Employer #1 - why did you leave this position? * Employer #2 * Employer #2 Phone * - Area Code Phone Number Employer #2 start and end dates * Employer #2 position held * Employer #2 names/ages of children * Employer #2 - can we use this employer as a reference? * Yes No Employer #2 hours * Employer #2 - was this position full-time or part-time? * Yes No Employer #2 - why did you leave the position? * Employer #3 * Employer #3 phone * - Area Code Phone Number Employer #3 start and end dates * Employer #3 position held * Employer #3 names/ages of children * Employer #3 - can we use this employer as a reference? * Yes No Employer #3 hours * Employer #3 - why did you leave the position? * Reference #1 Name * First Name Last Name Reference #1 Phone * - Area Code Phone Number Reference #1 Email * example@example.com Reference #2 Name * First Name Last Name Reference #2 Phone * - Area Code Phone Number Reference #2 Email * example@example.com Reference #3 Name * First Name Last Name Reference #3 Phone * - Area Code Phone Number Reference #3 Email * example@example.com Submit Should be Empty:
