Nanny Application

We are excited to work with you to help place you with a family. The information you provide on the application will help us in this process.

Please answer all questions as completely as possible to ensure a successful placement. Upon receipt of your nanny application we will contact you within 48 hours. Thank you!



City, State, Zip Code

Best Reached Phone Number

Drivers License number/Make & Model of car, if owner of a vehicle

Date Available


Desired length of employment

Position Desired:
 Full Time Live In Full Time Live Out Part Time
 Permanent Summer Placement Temporary

Are you currently employed?

Number of children you would like to care for?

Please indicate the hours you are available to work:

Sunday - Hours Available

Monday - Hours Available

Tuesday - Hours Available

Wednesday - Hours Available

Thursday - Hours Available

Friday - Hours Available

Saturday - Hours Available

What is your salary range?

Monthly Salary:

Weekly Salary:

Hourly Salary:

Duties you are willing to perform (check all that apply):
 Laundry Running Errands Tidying Up Miscellaneous

Please indicate which of the following meals you are willing to prepare:
 Breakfast Snack Lunch Dinner

Please indicate if you are willing to drive the children to the following:
 To School From School
 To activites From activities
 To friends' homes From friends' homes

Are you allergic to any animals?

Are you willing to care for the animal?

Are you interested in babysitting for other families?
 Yes No

Can you swim?
 Yes No

CPR Certified?

If yes, what is your CPR Expiration Date:

Driver's License?
 Yes No

Insurance Policy?
 Yes No

 Yes No

Employment History (starting with most recent)

Employer 1

Address (Employer 1)

City, State, Zip Code (Employer 1)

Phone (Employer 1)

Children's Ages (Employer 1)

Date Started (Employer 1)

Date Left (Employer 1)

Reason for Leaving (Employer 1)

Ending Salary (Employer 1)

Job Duties, be specific (Employer 1) :

Employer 2

Address (Employer 2)

City, State, Zip Code (Employer 2)

Phone (Employer 2)

Children's Ages (Employer 2)

Date Started (Employer 2)

Date Left (Employer 2)

Reason for Leaving (Employer 2)

Ending Salary (Employer 2)

Job Duties, be specific (Employer 2) :

Employer 3

Address (Employer 3)

City, State, Zip Code (Employer 3)

Phone (Employer 3)

Children's Ages (Employer 3)

Date Started (Employer 3)

Date Left (Employer 3)

Reason for Leaving (Employer 3)

Ending Salary (Employer 3)

Job Duties, be specific (Employer 3) :

Other Employment References:

Other Employment Reference 1:

Name (1)

Address / Business (1)

Phone Number (1)

Other Employment Reference 2:

Name (2)

Address / Business (2)

Phone Number (2)

Other Employment Reference 3:

Name (3)

Address / Business (3)

Phone Number (3)

Please provide two character references (work, school, religious, community):

Reference 1:

Name (Reference 1)

Phone (Reference 1)

Relationship (Reference 1)

Reference 2:

Name (Reference 2)

Phone (Reference 2)

Relationship (Reference 2)

Please write a short autobiography describing yourself, your interests, talents, school activities, and theories on how children should be treated and disciplined. What role will you as a nanny play in the lives of the children you are caring for? (This autobiography will be shared with your potential family).

I have completed this application as accurately and precisely as possible. I understand that any of the aforementioned references and/or employers can ansd will be contacted for verification of this information, and I understand that I may be subjected to a background check in addition to Trustline.

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