Nanny Application Form
Personal Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email address
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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
Curaçao
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
United States
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
Please upload a photo of yourself (or if you're using a mobile device, please take a selfie)
Do you have a Skype, WeChat, or Apple FaceTime Account for Video Chat?
Skype
WeChat
Apple FaceTime
None, but I'm going to sign up for Skype and email you my Skype Address
If you already have a Skype, WeChat, or Apple FaceTime address, please type it below
What is your nationality?
For how many years have you lived in the US?
*
What languages do you speak?
How old are you?
What is your martial status
Single
Married
Other
If you have children of your own, how old are they?
What is the highest level of education you have completed?
Some high school
High school diploma
GED
Some college
College degree
Advanced degree
if you went to college, please list the name of the school and the location
What was your major focus of study?
Where did you hear about us?
How many years have you been a nanny?
What ages of children do you have PROFESSIONAL nanny experience with?
Newborns (ages 0-6 months)
Infants (ages 6 months - 1 year)
Toddlers (ages 2-3)
Preschoolers (ages 4-5)
School age (ages 6-12)
Teenagers (ages 13 and up)
Do you have a valid driver's license?
*
Yes
No
Other
Do you have access to a car?
*
Yes
No
If a family were to run a background check on you, is there anything that would show up on the report?
*
What did you do before you became a nanny?
Are you certified in CPR?
Yes
No
Yes, but it has expired
Other
Are you certified in First Aid?
Yes
No
Yes, but it has expired
Other
Do you have any dietary restrictions or allergies that a family would need to know about?
Are you allergic to pets?
Have you ever seen a doctor for emotional issues, depression or mental disorder?
Nanny Job Information
Do you prefer a live-in or live-out position?
*
Live-in
Live-out
Either
Please indicate where you are willing to work
*
New York
New Jersey
Connecticut
Other
When are you available to begin a new nanny job?
What days are you available to work?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How early in the morning can you start
How late in the evenings can you stay?
If you were occasionally asked to stay later, would you be able to?
If you are a live-out nanny and the parents had to travel for business, would you be able to stay overnight on occasion with the children?
Yes
No
Sometimes
Other
Are you seeking full-time or part-time employment
*
Full-time
Part-time
Either is fine
Please indicate if you are ONLY interested in a weekend position
I am only interested in a weekend position
Please indicate if you are ONLY interested in a summer position
I am only interested in a summer position
What is your desired weekly take-home pay amount?
$400-500 and up
$501-600 and up
$601-700 and up
$701-800 and up
$801-900 and up
$901-1,000 and up
more than $1,000 per week
Do you have a preference for the ages of children that you work with?
Newborns (ages 0-6 months)
Infants (ages 6 months - 1 year)
Toddlers (ages 2-3)
Preschoolers (ages 4-5)
School age (ages 6-12)
Teenagers (ages 13 and up)
Do you have a preference to work with a stay-at-home mom or a working mom?
Stay-at-home mom
Working mom
Either is fine
Do you have experience working with twins, triplets and/or special needs children?
Yes
No
If yes, please describe your experience working with twins, triplets and/or special needs children
Do you have experience with newborns?
Yes
No
Please describe your experience with newborns
Can you swim?
*
Yes
No, but willing to learn
No, and don't want to learn
Do you cook?
*
Yes, for children only
Yes, for children and parents
No
Are you comfortable taking care of pets if a family requests that?
Will you do light housework?
Will you do heavy housework if there was a helper (mom or cleaning person)?
Yes
No
Some families would like their nannies to travel with them on vacations and during the summer. Please tell us your thoughts and availability around traveling with a family.
Can you travel within the US, outside the US or both?
I can only travel within the US
I can travel outside of the US
Neither - I cannot travel at all
Previous Work History
Most recent job/family name, phone number, email
*
Most recent job/family: what were the dates of this job?
Most recent job/family: where was this job and how did you find it?
Most Recent job/family: full-time or part-time?
*
Full-time
Part-time
Other
Most Recent job/family: live-in or live-out?
*
Live-in
Live-out
Other
Days worked
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Typical hours worked
*
What were the names and ages of the children when you STARTED?
*
What were the names and ages of the children when you ENDED?
*
What was your weekly or hourly salary?
*
Was the mom
*
At home with me full-time
At home with me part-time
Working out of the house full-time
Why did this job end?
*
Will this employer provide a good reference?
*
Additional Work History
Job #2 Name, phone number, email address
Job #2 what were the dates of this job?
Job #2: Where was this job and how did you find it?
Job #2 Full-time or part-time?
Full-time
Part-time
Other
Job #2 Live-in or live-out?
Live-in
Live-out
Other
Job #2 Days worked
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Job #2 Typical hours worked
Job #2 What were the names and ages of the children when you STARTED?
Job #2 What were the names and ages of the children when you ENDED?
Job #2 What was your weekly or hourly salary?
Job #2 Was the mom
At home with me full-time
At home with me part-time
Working out of the house full-time
Job #2 Why did this job end?
Job #2 Will this employer provide a good reference?
Additional Work History (3rd job if you have one)
Job #3 Name, phone number, email
Job #3 what were the dates of this job?
Job #3: Where was this job and how did you find it?
Job #3 full-time or part-time?
Full-time
Part-time
Other
Job #3 live-in or live-out?
Live-in
Live-out
Other
Job #3 Days worked
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Job #3 Typical hours worked
Job #3 What were the names and ages of the children when you STARTED?
Job #3 What were the names and ages of the children when you ENDED?
Job #3 What was your weekly or hourly salary?
Job #3 Was the mom
At home with me full-time
At home with me part-time
Working out of the house full-time
Job #3 Why did this job end?
Job #3 Will this employer provide a good reference?
Video Upload - please click on the "record" button below (or if using a mobile device, click on the "file upload" button and record a video of yourself using your phone) and answer the following question, "Hi - my name is ______ and I have been a nanny for ____ years. I love being a nanny because ___________"
Resume Upload
Reference Letter Upload (note you can attach multiple files here)
Upload a File
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