Job Application; A-1 Perfect Nanny

Job Application

Position You are Applying For: (please check at least one from each category) Full-Time Part-Time Temporary Summers Vacation Nanny Live-In Nanny Babysitter Housekeeper Companion House Sitter Pet Sitter
Last Name:	First Name:
Address:
City:	State:	Zip Code:
Home Phone:	Work Phone:	Cell Phone:
Fax Number:	E-Mail Address:
Social Security Number:	Drivers License Number:

Have you ever been convicted of a felony? Yes No If yes, please explain:
Have you ever had any traffic violations? Yes No If yes, please explain:
Age and Date of Birth:	American Citizen: Yes No
Gender: Male Female	Resident Alien: Yes No
Marital Status:	Resident ID#:
How many children do you have?
In case of emergency contact: Name: Phone: Address: City/State/Zip:

Highest level of education completed:
     Subjects of Interest or Special Awards:

     Hobbies/Interests:

Job History and Experience:
We require at least three jobs held.

Job 1: Dates of Employment: to

Name of Employer:

Phone Number:

Position(s) Held:

Duties and Responsibilities:

Job 2: Dates of Employment: to

Name of Employer:

Phone Number:

Position(s) Held:

Duties and Responsibilities:

Job 3: Dates of Employment: to

Name of Employer:

Phone Number:

Position(s) Held:

Duties and Responsibilities:

Job 4: Dates of Employment: to

Name of Employer:

Phone Number:

Position(s) Held:

Duties and Responsibilities:

For Nannies, Babysitters, Companions, & Overnight Newborn Care:

Please Check All That Apply:

      I Smoke I Will Work Around Animals

      I Do Not Smoke I Am First Aid/CPR Certified

      I Can Swim I Have Experience with Twins and/or Triplets

      I Can Drive a Car I Have Experience with the Elderly

      I Have My Own Car and will transport children or elderly

      I Have Experience with Overnight Newborn Care

      I Have Experience with Special Needs Children

What Ages Do You Prefer Working With?

What Ages Are You Most Experienced With?

How long do you plan to stay with a family?
Will you give at least a one year commitment? Yes No
** We understand that there are emergencies or situations due to which you may not be able to continue to work for the family, but we would appreciate it if you would give them at least a month notice if you plan on leaving.
How often would you like to get paid? Weekly Biweekly Monthly
Do you want to be responsible for doing your own taxes? Yes No
What is the name, address, and phone number of a next-door neighbor?
Name:
Phone Number:
Address:
City/State/Zip:

Please list three more references not related to you:

1: Name:

Phone Number:

2: Name:

Phone Number:

3: Name:

Phone Number:

For Housekeepers Only:
(Please check off all that apply to you.)

      I Will Vacuum I Will Mop

      I Will Sweep I Will Dust

      I Will Do Laundry I Will Fold Laundry and Put it Away

      I Will Iron I Will Prepare Food

      I Will Clean Ovens I Will Clean out the Refrigerator

      I Will Clean All Bathrooms I Will Clean All Bedrooms

      I Will Clean Mirrors I Will Clean All Windows

      I Will Water the Plants I Will Change the Litterbox

      I Will Clean Outside: Patio Furniture, Sweep, etc.

For Pet-Sitters Only:
(Please check off all that apply to you.)

      I Will Walk and Feed the Animals Everyday

      I Will Change the Litterbox

      I Will Bathe the Animals I Will Take in the Mail Everyday

      I Will Clean Cages I Will Pick Up After the Animals

      I Will Give Animals Shots and/or Medication if Needed

For House-Sitters Only:
(Please check off all that apply to you.)

      I Will Take in the Mail Everyday

      I Will Walk and Feed all Animals       I Will Change the Litterbox

      I Will Keep the House Neat       I Will Stay Overnight

      I Will Give Animals Shots and/or Medication if Needed

Thank for visiting A-1 Perfect Nanny.com. We hope to find a family that best suits your needs. We are an equal opportunity employer. Please submit your application and we will get back to you as soon as possible to set up an interview.