Personal Information  
  
	 
  
	*First Name: 
	 
  
	Middle Initial: 
	 
  
	*Last Name: 
	 
  
	*Street Address: 
	 
  
	*City: 
	 
  
	*State: 
	
		
			Select a State 
			Alabama 
			Alaska 
			Arizona 
			Arkansas 
			California 
			Colorado 
			Connecticut 
			Delaware 
			District Of Columbia 
			Florida 
			Georgia 
			Hawaii 
			Idaho 
			Illinois 
			Indiana 
			Iowa 
			Kansas 
			Kentucky 
			Louisiana 
			Maine 
			Maryland 
			Massachusetts 
			Michigan 
			Minnesota 
			Mississippi 
			Missouri 
			Montana 
			Nebraska 
			Nevada 
			New Hampshire 
			New Jersey 
			New Mexico 
			New York 
			North Carolina 
			North Dakota 
			Ohio 
			Oklahoma 
			Oregon 
			Pennsylvania 
			Rhode Island 
			South Carolina 
			South Dakota 
			Tennessee 
			Texas 
			Utah 
			Vermont 
			Virginia 
			Washington 
			West Virginia 
			Wisconsin 
			Wyoming 
		 
	 
   
  
	Other State: 
	 
  
	*Zip: 
	 
  
	*Job ID# (if specific position is being applied for) : 
	 
  
	Cell Phone: 
	 
  
	*Best Contact Number: 
	 
  
	*E-mail: 
	 
  
	Emergency Contact Name: 
	 
  
	Emergency Contact Number: 
	 
  
	*Are you an American Citizen?
					
						
					
						*Are you authorized to legally work in the USA? 
						  
   
  
	*Do you have a valid social security number?
		
		  
 
   
  
	*Do you have a valid Driver's License?
		
		  
 
   
  
	*Do you have a car?
		
		  
 
   
  
	*Is your car insured?
		
		  
 
   
  
	*Do you have any motor vehicle violations within the last three years?
					
						
					
						*Details 
						
					  
   
  
	*Has your license been suspended within the last three years?
					
						
					
						*Details 
						
					  
   
  
	*Have you had ANY accidents in the last three years including NO fault accidents?
		
		  
 
   
  
	*If offered a position are you able to make a minimum 1-year commitment?
		
		  
 
   
  
	*Are you available to start immediately?
					
						
					
						*Details 
						
							
								1 
							
								2 
							
								3 
							
								4 
							
								5 
							
								6 
							
								7 
							
								8 
							
								9 
							
								10 
							
								11 
							
								12 
							
						 
						 -
						
							
								1 
							
								2 
							
								3 
							
								4 
							
								5 
							
								6 
							
								7 
							
								8 
							
								9 
							
								10 
							
								11 
							
								12 
							
								13 
							
								14 
							
								15 
							
								16 
							
								17 
							
								18 
							
								19 
							
								20 
							
								21 
							
								22 
							
								23 
							
								24 
							
								25 
							
								26 
							
								27 
							
								28 
							
								29 
							
								30 
							
								31 
							
						 
						 -
						
							
								1950 
							
								1951 
							
								1952 
							
								1953 
							
								1954 
							
								1955 
							
								1956 
							
								1957 
							
								1958 
							
								1959 
							
								1960 
							
								1961 
							
								1962 
							
								1963 
							
								1964 
							
								1965 
							
								1966 
							
								1967 
							
								1968 
							
								1969 
							
								1970 
							
								1971 
							
								1972 
							
								1973 
							
								1974 
							
								1975 
							
								1976 
							
								1977 
							
								1978 
							
								1979 
							
								1980 
							
								1981 
							
								1982 
							
								1983 
							
								1984 
							
								1985 
							
								1986 
							
								1987 
							
								1988 
							
								1989 
							
								1990 
							
								1991 
							
								1992 
							
								1993 
							
								1994 
							
								1995 
							
								1996 
							
								1997 
							
								1998 
							
								1999 
							
								2000 
							
								2001 
							
								2002 
							
								2003 
							
								2004 
							
								2005 
							
								2006 
							
								2007 
							
								2008 
							
								2009 
							
								2010 
							
								2011 
							
								2012 
							
								2013 
							
								2014 
							
								2015 
							
								2016 
							
								2017 
							
								2018 
							
								2019 
							
								2020 
							
						 
					  
   
  
	*Do you have any concerns about your National Background clearances?
		
		  
	  
		Details 
		
	    
   
  
	*What is your birth date? Please Note: You must be 18 years old to be considered for representation
		
		  1 
		  2 
		  3 
		  4 
		  5 
		  6 
		  7 
		  8 
		  9 
		  10 
		  11 
		  12 
		 
	  -
	  
		1 
		2 
		3 
		4 
		5 
		6 
		7 
		8 
		9 
		10 
		11 
		12 
		13 
		14 
		15 
		16 
		17 
		18 
		19 
		20 
		21 
		22 
		23 
		24 
		25 
		26 
		27 
		28 
		29 
		30 
		31 
	   
	  -
	  
		1950 
		1951 
		1952 
		1953 
		1954 
		1955 
		1956 
		1957 
		1958 
		1959 
		1960 
		1961 
		1962 
		1963 
		1964 
		1965 
		1966 
		1967 
		1968 
		1969 
		1970 
		1971 
		1972 
		1973 
		1974 
		1975 
		1976 
		1977 
		1978 
		1979 
		1980 
		1981 
		1982 
		1983 
		1984 
		1985 
		1986 
		1987 
		1988 
		1989 
		1990 
		1991 
		1992 
		1993 
		1994 
		1995 
		1996 
		1997 
		1998 
		1999 
		2000 
		2001 
		2002 
		2003 
		2004 
		2005 
		2006 
		2007 
		2008 
		2009 
		2010 
		2011 
		2012 
		2013 
		2014 
		2015 
		2016 
		2017 
		2018 
		2019 
		2020 
	   
	 
  
	*Have you ever been a Nanny before?
		
		  
 
   
  
	*Do you smoke?
		
		  
 
   
  
	*Are you able to swim?
		
		  
 
   
  
	*Are you CPR Certified?
		
		  
	  
		*Details 
		*Are you willing to become CPR Certified?
		
		  
	    
   
  
	*Are you First Aid Certified?
		
		  
 
   
  
	*Do you fluently speak any other language?
		
		  
	  
		*Details 
		
	    
   
  
	*Do you prefer to work for a family that does all the payroll deductions for you?
		
		  
 
   
  
	*Do you have any experience working with TWINS or multiple children at the same time? If so, please elaborate.
		
		  
	  
		*Details 
		
	    
   
  
	*What is your marital status?
		
		  
 
   
  
	*Do you have children? (it's optional to answer so you can put NO if you'd rather not disclose but many parents find "real life" experience  beneficial)
		
		  
	  
		*Details 
		*How old are they?
		
		  
		
		0-12 years 
		  *What arrangements have been made for your child/children during the time period you would be working?
		  
			
		  
		   
	    
   
  
	*Some families prefer their nanny comes in uniform such as nurse scrubs; are you interested in positions that have this requirement?
		
		  
 
   
  
	*Do you know ANY sign language? Many families are introducing baby sign language before verbal communications!
		
		  
 
   
  
	*Do you enjoy reading to children? If so, please list out your favorite books to read to children. (Titles & Authors if possible)
		
		  
	  
		*Which One? 
		
	    
   
  
	*Do you intend to drive a vehicle to and from your nanny position? 
		  
	  
		*Please provide the make, model, year and color of the vehicle you will utilize. 
		
	    
   
  
	*Do you ENJOY cooking? If so, please describe a handful of specific meals you would feel comfortable preparing for the family that hired you!
		
		  
	  
		*Details 
		
	    
   
  
	*Is it safe to say you feel you have qualifications that make you more outstanding than other nannies that may be applying for the same role? If so, please explain what makes you stand out?
		
		  
	  
		*Details 
		
	    
   
  
	*Would you consider a live IN nanny position where your primary residence is the same as where you work?
		
		  
 
   
  
	*Do you feel you come from a close knit family?
		
		  
 
   
  
	*Do you participate in ANY form of volunteer work in your personal life?
		
		  
 
   
  
	*Do you consider yourself to be an outdoor person who enjoys sports and keeps physically active?
		
		  
 
   
  
	*Please tell ABC a little about yourself! (suggestions below) 
   
  
	*What is the highest level of education you have completed?
		
		  
 
   
  
	*Please list subjects of study and any certifications attained:  
   
  
	*Name of the College you attended: 
	 
  
	*Would you describe yourself as a high energy Nanny?
		
		  
 
   
  
	*Please explain your view/work ethic when it comes to cell phones, social media and TV watching during your work day as a nanny?  
   
  
	*Many families have pets in their home. Please tell us about your love of pets, your comfortability caring for them and what pets you have. 
   
  
	*Please describe yourself in detail concerning your personality, goals, family background, and why you want to be a Nanny.  
   
  
	Please fill in the blanks  
  
	 
  
	*The reason I have chosen to  be in the Nanny profession over any other is because:  
   
  
	I have been serving in some form of childcare for over
	   
   
  
	*I feel children are:  
   
  
	*My goal as a Nanny is to:  
   
  
	*I am willing to do housekeeping that includes:  
   
  
	*If I had to describe myself in five adjectives I would say that I am:  
   
  
	*Activities that I would like to incorporate in the daily plan for the family I care for would include:  
   
  
	*If asked to describe the perfect family seeking a Nanny like me I would hope they would be:  
   
  
	Position Desired  
  
	 
  
	*Check all that apply!
		
		  
  
   
  
	 
  
	*Do you consider yourself to be tech savvy? (able to communicate with parents through text, order groceries and/or order items online)
		
		  
 
   
  
	*Are you comfortable providing homework help if necessary?
		
		  
 
   
  
	*Do you play any instruments?
		
		  
 
   
  
	*Drug testing through Quest Diagnostics is required for representation. Are you comfortable submitting to this screening?
		
		  
 
   
  
	*Please check the age group of children you prefer to care for (check all that apply)
		
		  
  
   
  
	*What capacity of childcare experience do you have? Check all that apply.
		
		  
 
	  
		Details 
		
	    
   
  
  
	Childcare References:  Please list prior childcare positions you have held, beginning with your most recent childcare position and going back as many years as possible. Please feel free to include all nanny positions, daycare positions, babysitting as needed care, doula care, summer only camp counselor classroom setting positions and ANY child care capacity opportunities you've held. Contact information to verify references is critical so please be sure to include all necessary fields. Parents like to speak with other parents so it's perfectly okay to provide parent names and numbers instead of Institution/Daycare names and numbers if preferred.
 
  
	 
  
	*Most Recent/Current Position Title: 
	 
  
	*Description of Position  
	 
  
	*Dates of Employment: 
	 
  
	*Starting Pay and Ending Pay: 
	 
  
	*Direct Supervisor Name: 
	 
  
	*Direct Supervisor Contact Number and Email: 
	 
  
  
	 
  
	 
  
	*Prior Position Title: 
	 
  
	*Description of Position:  
	 
  
	*Dates of Employment: 
	 
  
	*Starting Pay and Ending Pay: 
	 
  
	*Direct Supervisor Name: 
	 
  
	*Direct Supervisor Contact Number and Email: 
	 
  
  
	 
  
	 
  
	*Additional Position: 
	 
  
	*Description of Position:  
	 
  
	*Dates of Employment: 
	 
  
	*Starting Pay and Ending Pay: 
	 
  
	*Direct Supervisor Name: 
	 
  
	*Direct Supervisor Contact Number and Email: 
	 
  
  
	 
  
	 
  
	Additional Position: 
	 
  
	Description of Position:  
	 
  
	Dates of Employment: 
	 
  
	Starting and Ending Pay: 
	 
  
	Direct Supervisor Name: 
	 
  
	Direct Supervisor Contact Number and Email: 
	 
  
  
	 
  
	 
  
	Additional Position: 
	 
  
	Description of Position:  
	 
  
	Dates of Employment: 
	 
  
	Starting and Ending Pay: 
	 
  
	Direct Supervisor Name: 
	 
  
	Direct Supervisor Contact Number and Email: 
	 
  
  
	 
  
	 
  
	Additional Position: 
	 
  
	Description of Position:  
	 
  
	Dates of Employment: 
	 
  
	Starting and Ending Pay: 
	 
  
	Direct Supervisor Name: 
	 
  
	Direct Supervisor Contact Number and Email: 
	 
  
  
	 
  
	Personal References  (Examples: neighbors, family members, mentor/teachers, friends, church leader/pastor etc.) Please list any references below that can support your charachter in terms of honesty and integrity.
 
  
	 
  
	*Personal Reference Name(s): 
	 
  
	*Relationship and Details: 
	 
  
	*Dates known: 
	 
  
	*Contact Number(s): 
	 
  
	*Email Address: 
	 
  
	 
  
	 
  
	*Personal Reference Name(s): 
	 
  
	*Relationship and Details: 
	 
  
	*Dates known: 
	 
  
	*Contact Number(s): 
	 
  
	*Email Address: 
	 
  
	 
  
	 
  
	Personal Reference Name(s): 
	 
  
	Relationship and Details: 
	 
  
	Dates known: 
	 
  
	Contact Number(s): 
	 
  
	Email Address: 
	 
  
	 
  
	
		 
   
  
	 Thank you for your application, an ABC Nanny Source Scheduling Coordinator will be contacting you promptly to review your information!ABC Nanny Source