Childcare Specialist Application

Date

Home Address:

Position Applying For (please circle one):

Part Time Nanny

Full Time Nanny

Applicant’s Full Name:

Email Address:

Home Address:

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone Number:

Cell Phone Number:

How long have you lived at your current address?

Do you have a valid driver’s license?

Do you have a car?

If yes, please list year, make and model of your car:

Have you ever been in any accidents or received any driving violations?

If yes, please explain and list the year:

Which ages do you have experience working with? (Please check all that apply)

Newborn to 9 months

9 months to 24 months

2 to 5 years old

5 to 10 years old

Older than 10 years

Special Needs and Disabled

Please specify:

What foreign language do you speak?

Please list at least 3 families you have babysat or nannied for:
(Day Cares, Church nurseries, and Summer camps are acceptable references)

Name of Family:

Phone number:

How long did you work for this family? (List specific years)

How many children did you care for?

What were their ages when you began babysitting for this family?

Name of Family:

Phone number:

How long did you work for this family? (List specific years)

How many children did you care for?

What were their ages when you began babysitting for this family?

Name of Family:

Phone number:

How long did you work for this family? (List specific years)

How many children did you care for?

What were their ages when you began babysitting for this family?

Education

High School Name (required):

Location of High School:

Did you graduate?:

Did or do you attend college?

If so, what is the name of the institution?

Type of degree you are pursuing? (please circle one)

Undergraduate

Graduate

Major/Minor desired

Current GPA:

Did you graduate? (Please circle one)

Yes

Still pursuing degree

Placement Requirements

Date available to start:

Hours and Days available:

Monday

From

Tuesday

From

Wednesday

From

Thursday

From

Friday

From

Are you willing to work on the weekends?

Yes

How long are you willing to commit

6 months

1 Year

2 Years

Describe any scheduling limitations for the next 12 months. Including current work schedules

Briefly describe some personal interests and hobbies you have:

What qualities do you possess that you believe would make you a good childcare provider?

How did you hear about us?

As part of our service to our families, we will conduct a criminal background check, a motor vehicle report history, a social security trace, and sexual offenders check. Do you give us permission to run these checks?

Yes

By signing below you certify that these statements are accurate and true. If you are hired by Merry Poppins To Order LLC. as a ChildCare Specialist, you agree to notify Merry Poppins To Order LLC. if any changes to your contact information are made.

Date

Childcare Specialist Application

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