Nanny Application Form

Your Name

Home Phone		Cell Phone
Work Phone

Address

City

Zip

Email address (we will not give your email address to anyone)

1) Do you have a valid driver's license and/or social security card?	YesNo
2) Do you need to bring a child with you to work?	YesNo
3) Do you have your own vehicle?	YesNo

If so, list:

Year Make Model

4) Date of High School Graduation

School Name

State

5) What type of position are you most interested in? (Check all that apply)

temporary permanent part-time full-time

6) Please check the days you are available to work and list the hours for each day:

7) Check the age groups listed below that represent your experience and list the number of years you have worked with that age group:

8) Place a check next to 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
Babysitter	years worked
Other - Describe:

9) How many childcare references (including name and phone number) are you able to provide?

10) Any additional information you would like us to know about you (Please list job # and copy and paste a resume here).

A Brilliant Nanny | PO Box 19004, Portland OR 97280 | 503-459-4055 | Contact Us