Docstoc

Nanny_Application

Document Sample
Nanny_Application Powered By Docstoc
					                                    All About Nannies, Inc.
                                           A Professional Placement Service
                                8912 E. Pinnacle Peak Road, Suite 511, Scottsdale, AZ 85255
                                                          (480) 948-3901


Last Name:_________________First Name: _________________ Middle: _____________ Any other Known Names: _________________

Home address:________________________________________________ City________________ State: _________Zip Code____________

What are your major cross streets?______________________________________________________________________________________

Phone: Home: (_____)____________________________ Cellular: (______)_______________________Pgr:__________________________

E-mail address:____________________________________________________________________Date of Birth: ______________________

Social Security #:____________________________________Are you eligible to work in the U.S.?__________________________________

Would you like to be on our “On Call” babysitting list?_______________________________

Would you like to be part of our Nanny Network?_______________

                                                   PLACEMENT PREFERENCES
Type of position you are seeking (check as many as apply):
______Permanent            _______Full-time          _______Days    __________Weekends     __________Work around school schedule
______Temporary            _______Part-time          _______Evenings   ________Live-In     __________Live-Out

Weekly Pay Requested?________________________________Hourly Rate: ____________________________________

Date you could begin work?________________________________________

Days/ Hours Available:_________________________________ Anticipated length of stay: (min of 1 year):_______________________

What is your favorite age group? ________________________________ Maximum # of children you would care for?__________________ _

Please circle the ages of children you would like to work with: Newborn (0-6mos)     Infant (7 mos – 1yr)

Toddler (1-2 ½ yrs)       Preschool (2 ½ - 5yrs)             School age (6+yrs)    All of the above

If requesting to work with newborns, what experience do you have?____________________________________________________________

Please check additional tasks that you are willing to do (KEEPING IN MIND THAT THE CHILDREN ARE ALWAYS YOUR FIRST
PRIORITY)
  CAR-POOLING               GROCERY                     LAUNDRY            LIGHT             TUTORING
                            SHOPPING                                         HOUSEKEEPING
  ERRANDS                   COOKING                     SWEEPING           DISHES            FEEDING PETS

Pets (How do you feel about animals: like, dislike, fear, allergic)______________________________________________________________




                                                                     1
                                                                DRIVING
                                     (Be Exact. An investigation team will obtain the DMV Report)


Do you have a vehicle? Yes       -      No       If yes, Make and Model of vehicle: ______________________________________________

Tags and Registration Current?        Yes    -   No    Driver’s license # _____________________________ Exp.Date:________________

State Issued:_____________________ Auto Insurance Company?___________________________________________________________

Policy #______________________________________________ Agents name and phone number:_________________________________

Any drivers license(s) issued in another state(s) in the last 10 years?___________________________________________________________

Do you have any speeding tickets?________________________ If yes, how many and date ticket(s) received:__________________________

Any other motor vehicle violations?_______________________Have you been in any car accidents? If yes, please explain:
Have you been in any car accidents?______ If yes, please explain.____________________________________________________________ _

Has your license ever been suspended? ______ If yes, please explain.___________________________________________________________


                                             PERSONAL AND FAMILY BACKGROUND
                                                        (optional)
Who do you live with: (alone, parent(s), roommate, boyfriend, etc.) _________________________________________________________ __

If boyfriend, how long dating, where does he live, where will he be when you are a nanny? ________________________________________
_________________________________________________________________________________________________________________

Any marriage plans?________________________________________________________________________________________________

Father’s name:_______________________________                 Mother’s name:____________________________________________

Father’s Business Phone:_______________________                       Mother’s Business Phone:____________________________________

Number and ages of brothers and sisters in your family:_____________________________________________________________________

Do you own any pets? If yes, who will take care of them while you are a nanny?_________________________________________________

Religion?_______________________ Do you need any time off to attend religious services? If yes, when?___________________________

At this time are you searching for job opportunities other than being a nanny? If yes, explain:______________________________________

_________________________________________________________________________________________________________________.

Do you smoke? _________                Would you work in a smoking environment? Yes or No

Could you work in a smoking environment?         Yes   or      No

Do you have any allergies? If yes, to what?__________________________________________________

Any dietary restrictions? If yes, what?___________________________________________________________________________________

Any visible body piercing or tattoos? If yes, explain?______________________________________________________________________ _

Do you speak a foreign language? If yes, which one(s)?_____________________________________________________________________




                                                                      2
Are you?:                  Married                       Divorced                  Widowed                   Separated

If yes, what is your maiden name? _____________________________________

Have you ever had a child?           Yes     or          No      If yes, how many children? What are their ages and where are your children?

_________________________________________________________________________________________________________________.

Would your prefer your employer’s home to be:            Meticulously Neat         Very Neat       Average             No Preference


                                              INDICATE YOUR INTERESTS BELOW
                                                 (Circle only one in each row)
     Music:              Very Much         Some-What           Not At All
     Computers:          Very Much         Some-What           Not At All
     Writing:            Very Much         Some-What           Not At All
     Sewing:             Very Much         Some-What           Not At All
     Movies:             Very Much         Some-What           Not At All
     Rollerblading:      Very Much         Some-What           Not At All
     Sports:             Very Much         Some-What           Not At All
     Piano:              Very Much         Some-What           Not At All
     Art:                Very Much         Some-What           Not At All
     Reading:            Very Much         Some-What           Not At All
     Shopping:           Very Much         Some-What           Not At All
     Swimming:           Very Much         Some-What           Not At All
     Skiing:             Very Much         Some-What           Not At All
     TV:                 Very Much         Some-What           Not At All

NANNY EDUCATION:
               Dates       Institution            City           State   Last Grade Completed          Area of Study              Degree
High School:
College:
College:
Trade School:
Other Courses:
Have you taken Child Development courses?
Have you taken any Education classes?

PERMANENT CHILD CARE EXPERIENCE: (Please list most recent first)
       Start/End Dates       Employer & Supervisor                       Address                Home/Office Phone               # of Kids/Ages
1.             /                             /                                       /                         /

Reason for leaving:                                                                                                           Gross Salary:
2.           /                                     /                                 /                            /

Reason for leaving:                                                                                                         Gross Salary:
3.           /                                     /                                 /                            /

Reason for leaving:                                                                                                         Gross Salary:


                                                                         3
BABYSITTING EXPERIENCE: Please list baby-sitting experience of 3 months or more, NOT including family members.
     Dates           Parent(s) Name                         Address                Home/Office Phone          # of children/ages
1.           I                                 I                               I                          I
2.           I                                 I                               I                          I
3.           I                                 I                               I                          I
4.           I                                 I                               I                          I
5.           I                                 I                               I                          I

CHARACTER REFERENCES: People who know you well. NOT child care references or family.
Name                       Address             Home/Office Phone                  Length and Nature of Relationship
1.________________________________________________________________________________________________________________
2.________________________________________________________________________________________________________________
3. _______________________________________________________________________________________________________________

VOLUNTEER WORK: Please list dates and organizations:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

OTHER WORK EXPERIENCE: Please list your most recent jobs NOT in the child care field
     Dates       Company                       Supervisor/Reference       Daytime Phone       Reason for Leaving

1. __________________________________________________________________________________________________________
   __________________________________________________________________________________________________________

2. __________________________________________________________________________________________________________
   __________________________________________________________________________________________________________

Clubs, Professional Associations, Organizational Affiliations: _______________________________________________________
___________________________________________________________________________________________________________

Are you CPR certified? (Only answer YES if it is current)                   YES      or      NO

In case of emergency, please contact: _______________________________________ Phone:_____________________________


                                                   HEALTH INFORMATION
Do you have any physical restrictions?________ If yes, please explain:_________________________________________
__________________________________________________________________________________________________.

Are you currently under a physicians care?_________ If yes, please explain:_____________________________________
__________________________________________________________________________________________________.

Have you ever been treated for any of the following? Please circle those that pertain to you.
Heart Disease                   Headaches                       Cancer                    Diabetes                   Hernia
Anorexia                        High Blood Pressure             Chest Pain                Aids                       STD’s

If yes, please explain:____________________________________________________________________________________

Have you ever suffered from any kind of substance abuse?___________ If yes, please explain:__________________________

When was your last physical? Date:_________________ Were there any problems?___________
If yes, please explain:____________________________________________________________________________________

                                                                      4
                                                  NANNY WRITTEN INTERVIEW
                             Please answer all of the following questions as completely as possible.
                                             DO NOT GIVE ONE WORD ANSWERS!

What did you like most about your mother/father’s parenting skills?




What qualities would you look for if you were hiring a nanny?




What do you see as your personality strengths?




What do you see as your personality weaknesses?




Describe your personality?




Describe your relationship with your family?



PERSONAL ESSAY Why do you feel you would make a good nanny? Please include special skills, activities you like to do,
special interests, and details about your personality. _____________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Please answer all of the following questions as completely as possible.
1. What types of stimulating activities can you do with a 6 month old to promote growth and development?




2. What are some activities you might do with a two year old?

                                                                      5
3. What would you fix a two year old for lunch?




4. What would you do if two children were fighting over the same toy




5. What would you do if a child felt hot, and seemed sick when he woke up from a nap?




6.What would you say to a six year old who tells you, “You are not my mommy, I don’t have to listen to you”?




7. How would you handle a temper tantrum?




8. How do you handle a child who screams when the parents get ready to leave?




9. List some reasons why a baby might cry.


If you can not find anything wrong, what are some ways to soothe a crying baby?



11. Do you have experience with special needs children?_______Please describe______________________________________________
______________________________________________________________________________________________________________

12. Please describe your child care philosophy regarding discipline. What methods do you use with specific ages?

Toddler:
Preschool:
School Age:

13. What would you say to a 3 year old who tells you he hates you?




14. It is a rainy day and you cannot take your 3 year old to the park. What indoor activities do you do?




                                                                        6
                                                         Authorization
I understand that the information on this application has been requested for the purpose of evaluating my qualifications for
employment by a family, as a child care provider. I also understand that I am not, and will not be an employee of All About
Nannies, Inc.

I hereby authorize you to request reference checks which may include information on my character, education, driving record,
police record, past employment, previous addresses, and social security number.

To the best of my knowledge, the information on this application is true. I understand that misrepresentation or omission of facts
in connection with the information provided may be sufficient cause for dismissal wherever discovered.

I permit All About Nannies, Inc. to show this application and all references to parents as a part of the evaluation process.

I agree to release, and hold All About Nannies, Inc. harmless for any act of the employer. I also agree to hold All About Nannies,
Inc. harmless of any claim as a result of the placement.

NOTICE: We will be requiring a criminal background check, driving record check, social security
verification, drug screening, sex offender check, national wants and warrants as well as a
psychological screening with a psychotherapist.

DISCLAIMER: There is no guarantee of employment. We reserve the right to disqualify any candidate.
____________________________________                              _________________________
Applicant’s Signature                                             Date


Disclosure:
This document serves solely as a clear and conspicuous written disclosure as required by the Federal Fair Credit
Reporting Act set forth in section 604 (b) to the Candidate that previous employment, education, social security, motor
vehicle report and criminal background check may be obtained for the purpose of this “Application” only.

By the signature below, the “Applicant” acknowledges that All About Nannies, Inc. has made this disclosure.

_____________________________________                             __________________________
Applicant’s Signature                                             Date

                                                     NOTICE:
                                               READ BEFORE SIGNING

If I fail to notify ALL ABOUT NANNIES, INC. of my placement with an employer they have referred me to, (either on
a temporary job or permanent job) and All About Nannies is not made aware of the placement, I will be liable to All
About Nannies, Inc. for the entire placement fee. (FOR EXAMPLE: If I send you to a family for a temporary job or an
interview and you secretly go behind All About Nannies, Inc and work for this family again or without the consent of
the agency you will be liable for fees.) I understand that All About Nannies, Inc. is a search and placement firm only,
and for no purpose whatsoever shall it be considered my employer.

__________________________________
Applicant’s Signature


                                                                  7
                             AUTHORIZATION FOR RELEASE OF INFORMATION


       I certify that this application was completed by me, and that the entries contained in this application are true and
complete to the best of my knowledge. I understand that any misrepresentations of facts or omissions of facts requested
on this application may be grounds for rejection of this application or dismissal from employment if subsequently
discovered.

        I understand that in connection with my being considered for employment, All About Nannies, Inc. and/or its
officers and employees or contractors, may conduct a background investigation, which may include, but is not limited
to contacting my references, former employers and educational institutions, and seeking information on my driving
record and any criminal records.

       In that regard, I request my former employers, references, educational institutions, which have information
about me, and all federal state or local governmental agencies, to provide to All About Nannies, Inc. and, its officers
and employees or contractors, any and all information and opinions about me that is in their possession.

        I hereby waive written notice of release of such information and opinions, and I release such former employers,
references, educational institutions, and credit agencies or reporting services from any liability or claim relating to the
release of such information and opinions and release All About Nannies, Inc. and it’s officers and employees or
contractors, from any liability for obtaining any such information. A photocopy of this signed authorization and waiver
shall be valid as an original.

       I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time
by me or All About Nannies, Inc. and/or its officers and employees, with or without cause and without any prior notice.
No representation to the contrary shall be authorized unless in writing and signed by the President of All About
Nannies, Inc. or (or another person specifically authorized by board resolution) and the employee.

       If hired, I agree to comply with all rules, regulations and employment policies of All About Nannies, Inc.



                                              Signature: _________________________________

                                              Date: _____________________________________




                                                            8

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:9
posted:12/18/2011
language:English
pages:8