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Agency
Blog
Contact
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Nanny Pay
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Agency
Blog
Contact
APPLICATION FORM
First Name:
Last Name:
Email:
Phone:
Address (# and Street):
City:
State/Province:
Postal Code:
Desired Job
Baby Nurse
Nanny
Housekeeper
Nanny/Housekeeper
Adult Companion
Babysitter
Cook
Driver
Personal Assistant
Other
PreferredSchedule
Weekdays (5 days)
Weekdays - Live-in
Weekdays - Morning
Weekdays - Afternoon
Weekend
Weekend - Live-In
Long Weekend
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Hamptons (summer live-in ok)
Temporary
Evening Babysitter
Preferred Schedule (text)
Do you drive?
Yes
No
Learner's Permit
Residency Status
U.S. Citizen
Green Card
Work Permit
Student Visa
Papers in Process
Live-in job ok?
Yes
No
Years of professional caregiver experience.
Expertise
Deep Housecleaning
Light Housekeeping
Cooking for Kids
Family Cooking
Newborn
Infant
Toddler
Pre-School
Child
Disabled Adult
Elderly Adult
Administrative (office work)
Driving
Swimming (personal experience ok)
Homework Help (K-5)
Certifications
BABY NURSE
CPR
RN (India or other country)
HHA
CNA
Other
Reference 1: month/year begin & end
Reference 1: Job Type
BABY NURSE
LIVE-IN NANNY
LIVE-OUT NANNY
LIVE-IN HOUSEKEEPER
LIVE-OUT HOUSEKEEPER
LIVE-IN NANNY/HOUSEKEEPER
LIVE-OUT NANNY/HOUSEKEEPER
LIVE-IN ADULT COMPANION
LIVE-OUT ADULT COMPANION
BABYSITTER
COOK
DRIVER
PERSONAL ASSISTANT
OTHER
Reference 1: Duties
bathing and dressing (baby)
diaper change
baby massage
bottle prep and sterilization
baby food prep and feeding
reading storybooks
singing and nursery rhymes
help with bathing and dressing (toddler/pre-school)
potty training
teach hygiene and grooming
manage daily schedule
maintain safe environment
homework help
playtime
arts and crafts
manage nap and sleep time
bedtime prep
plan activities and playdates
take to activities and playdates (no planning)
meal and snack prep
tidy up playroom
organize toy box, drawers and closets
child laundry
family laundry
Ironing and folding
family cooking/meal prep
light housekeeping
kitchen clean-up
empty trash
clean bathrooms
make parents beds
change linens
vacuum
sweeping and mopping
dusting
polish furniture
shopping and errands
water plants
pet care
other
Reference 1: Contact Info
Reference 1: age of children at hire
Reference 1: Reason for Leaving Job
Reference 2: month/year begin & end
Reference 2 Job Type
BABY NURSE
LIVE-IN NANNY
LIVE-OUT NANNY
LIVE-IN HOUSEKEEPER
LIVE-OUT HOUSEKEEPER
LIVE-IN NANNY/HOUSEKEEPER
LIVE-OUT NANNY/HOUSEKEEPER
LIVE-IN ADULT COMPANION
LIVE-OUT ADULT COMPANION
BABYSITTER
COOK
DRIVER
PERSONAL ASSISTANT
OTHER
Reference 2: Duties
bathing and dressing baby
diaper change
baby massage
bottle prep and sterilization
baby food prep and feeding
reading storybooks
singing and nursery rhymes
help with bathing and dressing (toddler/pre-school)
potty training
teach hygiene and grooming
manage daily schedule
maintain safe environment
homework help
playtime
arts and crafts
manage nap and sleep time
bedtime prep
plan activities and playdates
take to activities and playdates (no planning)
meal and snack prep
tidy up playroom
organize toy box, drawers and closets
child laundry
family laundry
Ironing and folding
family cooking/meal prep
light housekeeping
kitchen clean-up
empty trash
clean bathrooms
make parents beds
change linens
vacuum
sweeping and mopping
dusting
polish furniture
shopping and errands
water plants
pet care
other
Reference 2: Contact Info
Reference 2: age of children at hire
Reference 2: Reason for Leaving Job
Reference 3: month/year begin & end
Reference 3: Job Type
BABY NURSE
LIVE-IN NANNY
LIVE-OUT NANNY
LIVE-IN HOUSEKEEPER
LIVE-OUT HOUSEKEEPER
LIVE-IN NANNY/HOUSEKEEPER
LIVE-OUT NANNY/HOUSEKEEPER
LIVE-IN ADULT COMPANION
LIVE-OUT ADULT COMPANION
BABYSITTER
COOK
DRIVER
PERSONAL ASSISTANT
OTHER
Reference 3: Duties
bathing and dressing baby
diaper change
baby massage
bottle prep and sterilization
baby food prep and feeding
reading storybooks
singing and nursery rhymes
help with bathing and dressing (toddler/pre-school)
potty training
teach hygiene and grooming
manage daily schedule
maintain safe environment
homework help
playtime
arts and crafts
manage nap and sleep time
bedtime prep
plan activities and playdates
take to activities and playdates (no planning)
meal and snack prep
tidy up playroom
organize toy box, drawers and closets
child laundry
family laundry
Ironing and folding
family cooking/meal prep
light housekeeping
kitchen clean-up
empty trash
clean bathrooms
make parents beds
change linens
vacuum
sweeping and mopping
dusting
polish furniture
shopping and errands
water plants
pet care
other
Reference 3: Contact Info
Reference 3: Age of children at Hire
Reference 3: Reason for Leaving
Reference 4: Contact Info
Do you have a criminal record? Any history of sex abuse?
ALL OF THE ANSWERS I HAVE PROVIDED ON THIS APPLICATION ARE ARE CORRECT (YES/NO)
Yes
No
