Nanny Profile by jolinmilioncherie

VIEWS: 22 PAGES: 5

									                                                                                       CARE SOLUTIONS, INC.
                                                                                                    175 Strafford Avenue, Suite One
                                                                                                                   Wayne, PA 19087
                                                                                                                FAX: 610-645-0880
                                                                                                                  Tel: 610-645-6355

Nanny Profile
                                       APPLICANT INFORMATION

Full Name:                                                                                              Date:
               Last                                  First                                  M.I.
Address:
               Street Address                                                               Apartment/Unit #


               City                                                                         State               ZIP Code
Previous
Address:
               Street Address                                                               Apartment/Unit #


               City                                                                         State               ZIP Code
Cell
Phone: (              )                                       E-mail Address:
Home
Phone: (              )
Full Time or
Part Time?                           Live In or Live Out?                             Desired Salary:      $

Marital Status:                      # of Dependents                                  Age of Children
                                                  YES        NO
Are you authorized to work in the US?
Date of Visa or
Green Card                                                          # of Visa/Green Card
                                                  YES        NO
Have you ever been convicted of a felony?                         If yes, explain
                                                  YES        NO                                                            YES   NO
Do you have a valid U.S. Driver’s License?                        Any Accidents/Moving Violations in last 5 years?

Driver’s License #                                                                  State
                                                  YES        NO                                                            YES   NO
Do you have a reliable car?                                       Do you have auto insurance?

Make & Year of Car                                                         License Plate #
Are you available for Emergency Care on           YES        NO   Are you willing to drive children to school and          YES   NO
short notice?                                                     activities?

Tell us a little about yourself.

Describe your interests.
What duties do you enjoy the
most?
Describe your experience with
housekeeping, laundry &
cooking.
Why do you feel confident taking
care of children?
What aspect of child care has
been the most rewarding for you?
                                                  YES        NO
Are you experienced with infants?                                 If yes, explain
                                                  YES        NO
Are you experienced with toddlers?                                If yes, explain
Are you experienced with school age            YES     NO
children?                                                      If yes, explain
                                               YES     NO
Have you ever worked with a difficult child?                   If yes, explain
Do you have experience with a physically       YES     NO
handicapped child?                                             If yes, explain

Describe your health.
Do you currently take any prescription         YES     NO
medication?                                                    If yes, name
                                               YES     NO                                        YES   NO
Do you smoke?                                                  Do you swim?
                                               YES     NO                                        YES   NO
Will you prepare meals for children?                           Will you do light housekeeping?
                                               YES     NO                                        YES   NO
CPR Certified?                                                 First Aid Certified
                                               YES     NO      What is your
Do you like pets?                                              energy level?

How did you hear about us?



                                               EDUCATION

                                                       City,
                                                      State,
High School:                                            ZIP
                                                                  YES       NO
From:                  To:                 Did you graduate?                         Degree:


                                                       City,
                                                      State,
College:                                                ZIP
                                                                  YES       NO
From:                  To:                 Did you graduate?                         Degree:


                                                       City,
                                                      State,
Other:                                                  ZIP
                                                                  YES       NO
From:                  To:                 Did you graduate?                         Degree:
                          CHILD CARE EXPERIENCE
                                                           Home
NAME:                                                     Phone:   (    )

Address:                                                  Email:

City, State                                                 ZIP
                                    Starting Gross                 Ending Gross
Cell #:                                     Salary:   $                  Salary:   $

Responsibilities:
Date
From:               To:        Reason for Leaving:


                                                           Home
NAME:                                                     Phone:   (    )

Address:                                                  Email:

City, State                                                 ZIP
                                    Starting Gross                 Ending Gross
Cell #:                                     Salary:   $                  Salary:   $

Responsibilities:
Date
From:               To:        Reason for Leaving:


                                                           Home
NAME:                                                     Phone:   (    )

Address:                                                  Email:

City, State                                                 ZIP
                                    Starting Gross                 Ending Gross
Cell #:                                     Salary:   $                  Salary:   $

Responsibilities:
Date
From:               To:        Reason for Leaving:
                                              REFERENCES
Please list three personal or business references (please do not list relatives).

Full Name:                                                     Relationship:

Address                                                                        Phone:        (   )
City, State,
ZIP                                                                                 Email:


Full Name:                                                     Relationship:

Address:                                                                       Phone:        (   )
City, State,
ZIP                                                                                 Email:


Full Name:                                                     Relationship:

Address:                                                                       Phone:        (   )
City, State,
ZIP                                                                                 Email:


                                  DATES AND TIMES AVAILABLE


Mon.                                                                           From:                 To:

Tues.                                                                          From:                 To:

Wed.                                                                           From:                 To:

Thurs.                                                                         From:                 To:

Fri.                                                                           From:                 To:

Sat.                                                                           From:                 To:

Sun.                                                                           From:                 To:


                                               DISCLAIMER

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.



Signature:                                             Date:
                               BACKGROUND INFORMATION AUTHORIZATION

This authorization allows Care Solutions, Inc. to conduct investigations including background checks,
Department of Motor Vehicle reports, credit checks, reference checks, and education institution checks. I
release and discharge Care Solutions and its agents and associates to the full extent permitted by law from
any claims, damages, losses, liabilities, costs, expenses or any other charge or complaint filed with any
agency arising from retrieving and reporting this information.

I authorize and consent to release of records to the authorized representatives of Care Solutions, Inc.




Name:                                                                                          Date:
              Last                              First                                M.I.
Address:
              Street Address                                                         Apartment/Unit #


              City                                                                   State              ZIP Code




Driver’s
License #:                                              State:



Social Security #:                                                  Date of Birth:




Add photo for identification here:



Signature:                                              Date:

								
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