America's Nannies



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NANNY ONLINE APPLICATION

America's Nannies
PO Box 9151
Paramus, NJ 07653-9151
Phone: 1-888-NANNIES (1-888-626-6437)

Please complete the following application and we will be in touch with you shortly to discuss available opportunities. Until such time as we have a secure site, you may exclude your social security and drivers license numbers which we can get from you by phone.

* - Required Field

Step 1: Enter Contact Information

First Name:

Last Name:

Address:

City:

State:

Zip Code:

E-mail:

Home Phone:

Cell Phone:

Best Time to Call:

Fax:

Step 2: Enter Nanny Preferences

Live In or Live Out Position:

Date Available:

Salary Range:

Preferred Age Group:

Number of Children Preferred:

What is the youngest and oldest child you have worked with?

America's Nannies does not require family laundry or cooking. Some families request it. Please specify your willingness to do either: Housekeeping is expected for the children only.

Family Laundry:

Family Cooking:

Family Type (check all that apply):
   Single Mom
   Single Dad
   Non Working Mom
   Dual Parent

Step 3: Enter Location Preferences
Check one or more - we place nationally, but most of our placements are on the East Coast

   CT
   NJ
   NJ -North
   NY -Mostly Westchester County
   NY -NYC (we do not make placements in NYC as a general rule - ask us about why)
   VA, DC, MD
   East Coast
   Midwest
   West Coast
   South
   Other - Specify

Step 4: Enter Your Personal Information

Date Of Birth:

Birth Place:

Height:

Weight:

Marital Status:

Children:

Ages of Children:

Social Security Number:

Religious Affiliation (optional):

Do you have aproblems working if there are pets in the house?

Foreign Languages Spoken:

Musical Instruments Played:

Special Talents / Interests:

Clubs / Organizations:

List licenses (i.e. EMT, CNA):

First Aid Certified:

Certification Date:

CPR Certified:

Certification Date:

Are you a swimmer?

Swimming Level:

What is your highest level of education? If you have graduated from college, please let us know what you hold a degree in and if you have not yet graduated from college but have taken some courses please indicate the number of credits you have.

Highest Level of Education:

If you have not been doing full time nannying or attending school full time please give us a brief overview of what you have been doing with yourself up until now?

Do you know what you would like to do in the future, career wise?

Step 5: Enter Your Driving Information

Do you drive?

Do you drive a stick shift?

List tickets / accidents in the past 4 years:

Driver's License Number:

State Issued:

Expiration Date:

Do you own a car?

Make, Model & Year:

Do you own car insurance?

Will you be bringing it with you?

Step 6: Enter Your Childcare Experiences
Please include at least three references. References may include any type of work with children.

Childcare Experience: 1

Employer:

Contact Person:

City:

State:

E-mail:

Home Phone:

Business Phone:

Date From:

Date To:

Live In or Live Out:

Type:

Ages of Children Cared For:

Reason for Leaving:

Childcare Experience: 2

Employer:

Contact Person:

City:

State:

E-mail:

Home Phone:

Business Phone:

Date From:

Date To:

Live In or Live Out:

Type:

Ages of Children Cared For:

Reason for Leaving:

Childcare Experience: 3

Employer:

Contact Person:

City:

State:

E-mail:

Home Phone:

Business Phone:

Date From:

Date To:

Live In or Live Out:

Type:

Ages of Children Cared For:

Reason for Leaving:

Childcare Experience: 4

Employer:

Contact Person:

City:

State:

E-mail:

Home Phone:

Business Phone:

Date From:

Date To:

Live In or Live Out:

Type:

Ages of Children Cared For:

Reason for Leaving:

Step 7: Enter Your Medical Health Information

Do you now have or have been told that you have or suffer from any of the following? If your answer is yes, please comment in the alloted space below:

Frequent Headaches, fainting or dizziness:
Heart Problems:
Asthma, allergies, wheezing, emphysema:
Nervous or emotional disorders:
Diabetes or Kidney/bladder disorders:
Sight, speech or hearing problems:
Rheumatic fever or arthritis:
Menstrual problems (that can interfere w/a job)
Epilepsy or convulsions:
Cancer or tumors:
Injuries to back, neck, spine or disc:
Deformity or loss of limb:
Ulcer or disorder of stomach, gall bladder etc:
Tuberculosis:
Any type of eating disorders:
Please explain all above 'yes' answers.

In the past 3 years have you:
Consulted a Doctor Chiropractor or other health care provider:
Consulted a Psychologist, Psychiatrist or mental health counselor:
Had a Physical Exam, TB Test or Chest X-ray:
Been advised to change occupations for health reasons:
Been diagnosed w/AIDS, Hepatitis or other communicable diseases:
Been treated or counseled for alcohol or drug abuse/addiction:
Please explain all above 'yes' answers:

Are you willing to take a drug, AIDS or TB test if requested to so by the family at their expense?
Are you pregnant or do you suspect that you are pregnant?
Do you currently take any prescribed medications?
If 'yes', for what reason and in what dosage are you taking it?

Is there anything in your family history that should concern us or the family that employs you to be their nanny? (i.e : a jealous spouse chasing you, tendency to emotional instability, etc)
If 'yes', please explain:

Do you SMOKE?
If you smoked before please describe your smoking habits and tell us when you last smoked:

Please tell us which is the word that describes your alcohol drinking habits:

Physician Name:

Physician Address:

Physician Phone Number:

I, understand that the nanny position I am applying for requires me to be in good physical and mental health. I declare that all statements and answers above are true and complete to the best of my knowledge. I understand that any omissions or misrepresentations may be sufficient cause for immediate termination of employment by my host family. I authorize my physician to release all information regarding my physical and emotional history.

Step 8: Employment Eligibility Verification and Authorization for Clearances

First Name:

Middle Name:

Last Name:

Maiden Name:

Current Address:

City:

State:

Zip Code:

Date of Birth:

Social Security Number:

I attest, under penalty of perjury, that I am (check a box)

A Citizen or National of the United States
An alien lawfully admitted for permanent residence (Alien Number A:

An alien authorized by the Immigration and Naturalization Service to work in the United States (Alien Number A: , or Admission Number , expiration of employment authorization, if any ).

, I attest, under penalty of perjury, the documents that I have presented as evidence of identity and employment eligibility are genuine and relate to me. I am aware federal law providers for imprisonment and/or fine for any false statements or use of false documents in connection with the certificate.

Step 9: Authorization for Clearance

First Name:

Middle Name:

Last Name:

Enter Your Current Address:

Address:

City:

State:

Zip Code:

Enter Your Prior Address:

Address:

City:

State:

Zip Code:

Date of Birth:

Birthplace (Town and State):

Your Father's Full Name:

Your Mother's Full Name (plus maiden name):

Your Social Security Number:

Your Driver License Number and State:

, I authorize America's Nannies to verify the records noted above. I understand that this information will be provided to my employer only and will not be distributed to any other party by America's Nannies under penalty of Federal Law. Your employer has been informed by America's Nannies that they may not distribute this information to any other party at any time.

Step 10: Enter Essay Questionnaire
Please answer all of the following questions in as much detail as possible. These questions are your chance to really express yourself and to allow a family to get to know you.

1. Why do you want to be a nanny?

2. Why do you feel you would be a good nanny?

3. Describe your experiences with children (include scope of responsibilities, training, etc)

4. What have your experiences taught you about working with children?

5. Describe a difficult situation that you've had with a child and how you handled it.

6. How would you discipline a misbehaving child?

7. Describe your family background (parents, siblings, birthplace, childhood, etc.)

8. How do you normally spend your leisure time and your time with friends (hobbies, activities you enjoy doing, etc.)?

9. How would you describe yourself (personality, character, interests, etc.)?

10. What would you say are your greatest strengths and weaknesses?

11. What values are most important to you in your life?

12. Have you traveled away from home before (explain) and if not would you feel comfortable being away from home? (Not required for live out applicants.)

13. Do you have friends or relatives in the NY, NJ, CT or PA areas? (Our most common placement areas)

14. Are there any health problems we should know about that might affect your ability to be an effective nanny?

15. Do you take any medications on a regular basis (do not include birth control)

16. Does your family support your decision to be a nanny?

17. How would you handle a disagreement with your host family?

18. What do you see as the nanny's role in the family environment?

19. Are you capable of planning and preparing nutritious meals for children or would you prefer guidance in this area from your host family?

20. Do you have any readily visible piercings or tattoos that may offend some families looking for nannies? (This will not prevent us from finding you a nanny position, but there is no point in looking for a job with a host family for which this will be a problem)

21. If you were hiring a nanny for your own children, what special quality or qualities would you look for in that position?

22. Write a letter to a perspective family telling them a little bit about yourself and your goals. (What do you plan to do in the future, anything else they should know about you that has not already been talked about, school goals, family goals, etc.)

Step 11: Candidate Acknowledgement

Referrals made to families are totally free to you. However, you are obligated to inform us if any family makes an attempt to hire you independently of the agency. Failing to do so and then taking a job with such a family could make you liable for the payment of the placement fee. Always remember that a family that is out to cheat the agency will do their best to cheat you as well.

, I accept and understand the above statement. *

© 1997-2008 America's Nannies�
All rights reserved.

For more information call 1-888-NANNIES (1-888-626-6437).
Placing Professionally Screened & Referenced Full Time Live In Nannies Nationwide.
Nanny Agency specializing in New Jersey ( NJ ), New York ( NY ) and Connecticut ( CT )