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Nanny Application Form

Basic Details:

First Name: Last Name:
Address: Apt/Suite:
City: Province:
Postal Code: Email:
Date of Birth:
(dd/mm/yyyy)		    
Home Phone: Work Phone:
In case of emergency,
Please contact:		      
Name: Phone:

Educational Experience:

Please list relevant educational experiences in reverse chronolgical order.
Institution Name: Qualifications:
Institution Name: Qualifications:
Institution Name: Qualifications:

Employment Experience:

Please list relevant employment experiences in reverse chronological order.
Employer Name: Position:
Address: Apt/Suite:
Employer Phone: Live: In Out
Duties:    
Start Date:
(dd/mm/yyyy)		 End Date:
(dd/mm/yyyy)
Reason for Leaving:    
Employer Name: Position:
Address: Apt/Suite:
Employer Phone: Live: In Out
Duties:    
Start Date:
(dd/mm/yyyy)		 End Date:
(dd/mm/yyyy)
Reason for Leaving:    
Employer Name: Position:
Address: Apt/Suite:
Employer Phone: Live: In Out
Duties:    
Start Date:
(dd/mm/yyyy)		 End Date:
(dd/mm/yyyy)
Reason for Leaving:    
Do you have any newborn experience? Yes No
Do you have any special needs experience? Yes No
If yes, please provide details:
Any other related experience? Please provide details:

 

My Employment Preferences:

What locations would you consider working in? (e.g. Rosedale)
First Choice: Second Choice:
Available on:
(dd/mm/yyyy)		 I prefer to live: In Out
Expected Pay:
(Net/Week)		 $ Previous Salary:
(Net/Week)		 $
Overtime Rate:
(Per Hour)		 $    
Prefered age of children
to care for:		    

 

I am willing to do:
Child's Laundry Yes No Child's Bedding Yes No
Family Laundry Yes No Family Bedding Yes No
Child's Ironing Yes No Family Ironing Yes No
Child's Cooking Yes No Family Cooking Yes No
Child's Room Yes No Vacuuming Yes No
Dusting Yes No Cleaning Bathrooms Yes No
Sweeping Kitchen Yes No Washing Kitchen Yes No

Any other housework tasks? (Please specify)
Would you consider Nanny Sharing? Yes No
Do you prefer parents to work out of the home? Yes No
Would you consider working for a single parent? Yes No

Additional Information:

Do you have current First Aid/CPR certificates? Yes No
Are you willing to take a First Aid/CPR course? Yes No
Are you a competent swimmer? Yes No
Please indicate any specific certificates or swimming experience:
Are you a smoker, social or otherwise? Yes No
Are you comfortable with pets? Yes No
If not, please provide additional details:
Do you have children of your own? Yes No
If yes, please provide additional details/ages:
Do you have any allergies? Yes No
If yes, please provide additional details:
What are your hobbies and interests?:
What qualities do you offer a family looking for a nanny?:
Communication/Languages:
English: Speak Write
French: Speak Write
German: Speak Write
Spanish Speak Write
Driving/Vehicles:
Do you have a full Canadian Driver's License? Yes No
If yes, what date was it obtained?
Have you ever had your license suspended? Yes No
If yes, please provide details:
Are you an experienced driver? Yes No
Can you drive a standard transmission/shift? Yes No
Legal Information:
Do you have a criminal record? Yes No
Are you willing to have a police check? Yes No
I hereby certify that the information provided on this application for is true.


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