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 For background checking purposes, please list the city, state and zip code(s) in which you have lived over the past 10 years, and/or any other names you've gone by. If you've always lived at the address listed above and always had the same name, please type "see above" in the box. 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.