Santa Fe Nannies - Nanny Application
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Personal Information
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| Name
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| Address
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| Email Address
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| Phone Number
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| Date of Birth
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| Are you eligible to work in the United States?
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Yes No
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POSITION/AVAILABILITY:
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| Check all Positions you may be interested in:
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Nanny Babysitter Mother's Helper Baby Nurse Home Manager Personal Assistant Sleep Consultant Newborn Specialist
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| Days Available
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Monday Tuesday Wednesday Thursday Friday Saturday Sunday Any
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| Hours Available
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Full-Time Part-Time For specific Day/Hour availability, please enter information below.
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| What date are you available to start work?
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| Desired Salary
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| Are you able to give a one year commitment?
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Yes No
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| Check all that apply
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Full-time Live In Part-time Live Out
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| Are you currently CPR/First Aid Certified?
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Yes No
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| Are you available on a regular basis for temporary/ babysitting jobs?
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Yes No
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GENERAL INFORMATION:
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| Do you have any physical conditions that will affect your job performance?
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| Do you smoke?
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Yes No
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| Would you have a problem lifting babies or children 30 lbs and over?
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Yes No
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| If Yes, Please Explain:
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| Is There Anything In Your Past Or Present Medical History You Would Like To Share, That Could Be Pertinent To Your Care Of A Child?
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Yes No
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| If Yes, Please Explain:
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| Do You Swim Well Enough to Save a Drowning Child?
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Yes No
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| With whom do you live?
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| If you have children, who would care for them if they were sick?
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| How do you feel about pets?
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| Do you have any allergies?
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EDUCATION:
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| Are you currently attending college? If so, what are your days and hours?
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| Name and Address Of School - Degree/Diploma - Graduation Date
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| Skills and Qualifications: Licenses, Skills, Training, Awards
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| Describe your short and long term goals.
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EMPLOYMENT HISTORY(Non-childcare related):
Present Or Last Position:
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| Employer:
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| Address:
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| Supervisor:
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| Phone Number
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| Email
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| Position Title:
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| Start Date
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| End Date
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| Responsibilities:
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| Salary
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Input hourly wage, if not salaried.
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| Reason for Leaving:
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Previous Position
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| Employer:
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| Address:
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| Supervisor:
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| Phone Number
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| Email
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| Position Title:
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| Start Date
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| End Date
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| Responsibilities:
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| Salary
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Input hourly wage, if not salaried.
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| Reason for Leaving:
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| May We Contact Your Present Employer?
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Yes No
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ESSAY QUESTIONS
Please articulate your answers thoroughly.
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| Describe your ideal family/employer:
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| Describe your philosophy of disciplining children. Give an example.
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| How do you comfort children? How do you deal with separation anxiety?
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| How would you sooth a crying infant?
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| If you were preparing a lunch for a 3 year old, what would be on the menu?
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| What do children like best about you?
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| Do you enjoy cooking? Describe.
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| List any foreign languages you speak fluently.
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| What are your skills, hobbies and talents?
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| Describe why you want to be a nanny.
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| Check All Age Groups You Have Cared For:
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Newborn Preschool Toddler School-Aged
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| With What Ages Are You Most Comfortable?
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Newborn Preschool Toddler School-Aged
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| Do you have experience with multiples?
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Yes No
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| Check all that you are willing to do:
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Childcare Errands Grocery Shopping Ironing Cooking Laundry Dishes Floors Pick up after children Personal Assistant Managing Others
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CHILDCARE EXPERIENCE
All References must be Non-Related
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| 1. Reference Name
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| Email
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| Home Phone
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| Work Phone
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| Best Time to Call
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| Position Held:
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| Dates of Employment
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| Hours per Week
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| Starting Salary
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| Ending Salary
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| How many children did you care for?
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| Initial Ages of Children
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| Primary Duties:
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| Length of time with the Family?
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| Reason for Leaving?
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| 2. Reference Name
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| Email
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| Home Phone
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| Work Phone
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| Best Time to Call
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| Position Held:
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| Dates of Employment
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| Hours per Week
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| Starting Salary
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| Ending Salary
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| How many children did you care for?
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| Initial Ages of Children
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| Primary Duties:
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| Length of time with the Family?
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| Reason for Leaving?
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| 3. Reference Name
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| Email
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| Home Phone
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| Work Phone
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| Best Time to Call
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| Position Held:
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| Dates of Employment
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| Hours per Week
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| Starting Salary
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| Ending Salary
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| How many children did you care for?
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| Initial Ages of Children
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| Primary Duties:
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| Length of time with the Family?
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| Reason for Leaving?
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BACKGROUND VERIFICATION CONSENT & RELEASE
Privacy Notice: For your protection, information from sensitive documents such as your Social Security and Drivers License numbers are not requested on this form. They will be required after your application is accepted and MUST be verified in order to complete your application.
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| List all Previous Last Names:
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| Previous Address
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| Previous Address
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VEHICAL INFORMATION
Please Verify Reliable Vehicle Information
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| Year/ Make/ Model
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| Insurance Provider
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| Policy Number
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| Expiration
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| How Long Have You Been Driving?
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| Describe Your Driving History
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| Do you have a criminal record?
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Yes No
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| If yes, Please Explain.
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| Upload a Photo
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This photo will be sent with your file to potential families.
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I certify that I have reviewed the forgoing information supplied by me, and it is true and correct to the best of my knowledge. In accordance with the Privacy Act, Freedom of Information Act, and the Fair Credit Reporting Act, I expressly authorize any person associated with any education institution, past or present employer, law enforcement agency or court to release this information to the background agency for the purpose of being considered for employment. I also authorize that a copy of this release be considered as an original. I hereby consent for Santa Fe Nannies to release all information collected in my application to prospective families.
I agree to not accept a position if the fee has not been paid. If a fee is unpaid, and I choose to remain in the position, I AGREE TO PAY THE REFERRAL FEE MYSELF.
If any Santa Fe Nannies client offers a position to me with the intent of avoiding payment, I agree to report to Santa Fe Nannies the same day. If I accept such a position, I agree to pay the appropriate fee to Santa Fe Nannies in full.
I agree to not accept second-party referrals. If I accept a second party referral from a Santa Fe Nannies Family, I AGREE TO PAY THE REFERRAL FEE MYSELF.
I agree not to refer friends or family members to any Santa Fe Nannies client. If I do so, I agree to pay the appropriate fee to Santa Fe Nannies in full.
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| Do you agree with the terms and conditions?
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Yes, I agree.
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| Initial
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| Date
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You MUST File in Our Office Before Starting Your New Position:
*First Aid and CPR certification.
*A five-year certified copy of your driving record from MVD.
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Before submitting please verify that all fields with an asterisk have been completed.
* Your application was successfully submitted if you are taken to a confirmation page.
* If you are not taken to a confirmation page please scan through your application for red flags.
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Image Verification
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