Nanny Application

Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*

Education Information
Which job are you applying for?*
Did you graduate?
Check all that apply
- High school
- College/university
- Advanced degree
Name of College/university
Degree details
Degree Major/minor Graduation Year
Are you currently attending college?*
- Online
- Classroom
- None
Do you have first aid?*
- Yes
- No, but I am willing to obtain/renew
When were you most recently certified?
Do you have CPR?*
- Yes
- No, but I am willing to obtain/renew
When were you most recently CPR certified?

Employment History
List your jobs for the last 7 years or most recent five jobs in chronological order. These should include your childcare and non-childcare positions.
*
Employer Name Supervisor Name/Title Supervisor Phone Your Job Title
*
Start Date (month/year) End Date (month/year) # Hours Worked Weekly Age of Each Child at Job Start Was Travel Required?
Please check any duties performed consistently
- Driving
- Kid's laundry
- Family laundry
- Tidy kitchen
- Add'l light housekeeping
- Cook for entire family
- Home organization projects
- Grocery shopping
- Errands
- Pet care
*
List Any Additional Benefits Such as Health Insurance, Bonus etc. Why Did this Position End?
Add another job?*
- Yes
- No

Job #2
*
Employer Name Supervisor Name/Title Supervisor Phone Your Job Title
*
Start Date (month/year) End Date (month/year) # Hours Worked Weekly Age of Each Child at Job Start Was Travel Required?
Please check any duties performed consistently*
- Driving
- Kid's laundry
- Family laundry
- Tidy kitchen
- Add'l light housekeeping
- Cook for entire family
- Home organization projects
- Grocery shopping
- Errands
- Pet care
*
List Any Additional Benefits Such as Health Insurance, Bonus, etc. Whye Did This Position End?
Add a 3rd job?*
- Yes
- No

Job #3
*
Employer Name Supervisor Name/Title Supervisor Phone Your Job Title
*
Start Date (month/year) End Date (month/year) # Hours Worked Weekly Age of Each Child at Job Start Was Travel Required?
Please check any duties performed consistently*
- Driving
- Kid's laundry
- Family laundry
- Tidy kitchen
- Add'l light housekeeping
- Cook for entire family
- Home organization projects
- Grocery shopping
- Errands
- Pet care
*
List Any Additional Benefits such as Health Insurance, Bonus etc. Why Did this Position End?
Add a 4th job?*
- Yes
- No

Job #4
*
Employer Name Supervisor Name/Title Supervisor Phone Your Job Title
*
Start Date (month/year) End Date (month/year) # Hours Worked Weekly Age of Each Child at Job Start Was Travel Required?
Please check any duties performed consistently*
- Driving
- Kid's laundry
- Family laundry
- Tidy kitchen
- Add'l light housekeeping
- Cook for entire family
- Home organization projects
- Grocery shopping
- Errands
- Pet care
*
List Any Additional Benefits Such as Health Insurance, Bonus, etc. Why Did This Position End?
Add a 5th job?*
- Yes
- No

Job #5
*
Employer Name Supervisor Name/Title Supervisor Phone Your Job Title
*
Start Date (month/year) End Date (month/year) # Hours Worked Weekly Age of Each Child at Job Start Was Travel Required?
Please check any duties performed consistently*
- Driving
- Kid's laundry
- Family laundry
- Tidy kitchen
- Add'l light housekeeping
- Cook for entire family
- Home organization projects
- Grocery shopping
- Errands
- Pet care
*
List Any Additional Benefits Such as Health Insurance, Bonus, etc. Why Did This Position End?

Describe any additional childcare experience
Such as long- term babysitting, raising your own children, volunteer work with children, oldest sibling of large family, assisted with in home daycare growing up etc.

Do you have a car that you will drive to work and have available through the day for potential driving of the children in your care?*
- Yes
- No
Car information
Make Model Year
In the past three years, have you had any at fault speeding tickets or accidents?*
- Yes
- No
If yes, please list dates and explain
Ticket Date Explanation
Has your license ever been suspended or revoked?*
- Yes
- No
If yes, please explain
Have you every been convicted of a crime?*
- Yes
- No
If yes, please explain
Are you willing to work occasional overnights?*
- Yes
- No
Are you willing to work occasional weekends?*
- Yes
- No
Are you willing to travel in your job?*
- Yes
- No
Please enter the name of your Colorado Nanny Recruiter (put "none" if not applicable):*

Contact Information

Degree	Major/minor	Graduation Year

Ticket Date	Explanation