Your Name Primary Phone Secondary Phone Address City State ZIP Your Email How did you hear about us? YahooGoogleCity SearchCare.comReferralOther How did you hear about us? ---YahooGoogleCity SearchCare.comReferralOther If referral or other Do you have a valid driver's license and/or social security card? YesNo Do you have a valid driver's license and/or social security card? ---YesNo Do you need to bring a child to work? YesNo Do you need to bring a child to work? ---YesNo Vehicle Information Do you have your own vehicle? YesNo Do you have your own vehicle? ---YesNo If Yes, list: Vehicle Year Vehicle Make Vehicle Model High School Information Date of High School Graduation High School Name State Have you ever been charged and/or convicted of a misdemeanor or felony? If yes, please describe below. What type of position are you most interested in? Check all that apply. TemporaryPermanentPart-timeFull-time Please list the times you are available to work for each day. Be sure to indicate AM / PM Monday: to Tuesday: to Wednesday: to Thursday: to Friday: to Saturday: to Sunday: to Please enter the number of years you have worked with each age group: 0-12 month age group: years of experience 1-3 year age group: years of experience 3-5 year age group: years of experience 5-12 year age group: years of experience 12+ age group: years of experience Please enter your experience for any and all positions that represent your childcare experience: Nanny: years worked Daycare: years worked Elementary school teacher or aid: years worked Preschool: years worked Camp counselor: years worked Church facility: years worked Household manager: years worked Doula or Midwife: years worked Other - please describe Please indicate your salary range and/or hourly wage expectations below. Please cut and paste your resume with references below. The agency will ultimately require a word or pdf document that includes a nanny resume and reference list in one document. Please indicate the job numbers from our site that are of most interest to you if applicable.