"A person's a person no matter how small" Dr.

Seuss
1839 Ygnacio Valley Rd., Suite 100 Walnut Creek, CA 94598 Phone (925)755-8555 Fax (925)755-8555 Bayareapremiernannies@gmail.com
Nanny Application
1. CONTACT INFORMATION OF APPLICANT Ph#:
Name: Cell #:
Address: Email:
2. EMERGENCY CONTACT PERSON: Ph#:
3. EDUCATIONAL EXPERIENCE
Education Yes No School Name City, State Dates Attended
High School Diploma G.E.D. __Yes __ No
Trade/Vocational School Major:
College Major:
Other Training or Seminars:

4. EMPLOYMENT EXPERIENCE (Starting with the most recent)

A. Company or Family's Name: Manager's Name:
Address Phone #:
Dates employed: May we contact this employer? __Yes or __No
Reason for leaving:
B. Company or Family's Name: Manager's Name:
Address Phone #:
Dates employed: May we contact this employer? __Yes or __No
Reason for leaving:
C. Company or Family's Name: Manager's Name:
Address Phone #:
Dates employed: May we contact this employer? __Yes or __No
Reason for leaving:
D. Company or Family's Name: Manager's Name:
Address Phone #:
Dates employed: May we contact this employer? __Yes or __No
Reason for leaving:
E. Do you have experience with newborns (less than six months old)? __ Yes or __ No
If yes, describe your duties:

F. Do you have experience with multiples (twins and/or triplets)? __ Yes or __ No

If yes, describe your duties:

G. Do you have experience with special needs? __ Yes or __ No

If yes, describe your duties:
 5. TRANSPORTATION
Rea
A. Do you have a valid CA driver's license? __Yes or __ No CDL#: Exp. Date:
B. Do you have your own car? __Yes or __No If yes, are you willing to drive it during work hours if paid for mileage? __Yes or __No
C. Have you been in a car accident? __Yes or __No If so, explain:

D. Have you had your license suspended? __Yes or __No If so, explain:

E. Do you have a clean driving record? __Yes or __No If not, explain:

6. PERSONAL INFORMATION
A. Have you been convicted of a crime? __Yes or __No If so, explain:

B. Are you Trustline registered? __Yes or __No If so, date: If not, are you willing to get certified? __Yes or __No
C. Are you CPR certified? __Yes or __No If so, date: If not, are you willing to get certified? __Yes or __No
D. Do you know how to swim? __Yes or __No
E. Are you a smoker? __Yes or __No If not, are you comfortable with a family that smokes? __Yes or __No
F. Do you have health insurance? __Yes or __No If not, do you want the family your work for to provide it? __Yes or __No
G. Do you have your own children? __Yes or __No If yes, will you bring them to work with you? __Yes or __No
7. TYPE OF EMPLOYEMENT YOU SEEK
A. __Live-in or __Live-out __Full-time or __Part-time or __Temp or __On-call sitter
B. Days and hours you are available:
C. What cities would you be willing to work in?
D. Are you comfortable with parents working at home? __Yes or __No
E. Are you comfortable with video monitoring if you are informed? __Yes or __No
(It is the legal right of families to monitor their homes without consent of the nanny)
F. If asked, would you be willing and able to travel with the family? __Yes or __No
G. Are you able to commit to at least one (1) year at your placement? __Yes or __No If not, how long can you commit to?
H. Which of the following duties are you willing and able to perform? Please "X"
__picking up after the children __Driving to activities __Help with homework __Grocery shopping
__Light house cleaning __Cooking for the entire family __Children's laundry/ironing __Parent's laundry/ironing
__Family errands __Other:

I. Working with children requires the following abilities: Patience, flexibility, standing or sitting for long periods of time, carrying
25+ pounds, receiving directions with a positive attitude, using appropriate speech, dressing appropriately, moving quickly, not
allowing your emotional or physical health problems negatively affect the family and/or children.
Are you willing and able to perform in this manner? __Yes or __No
J. Explain anything else you would like Bay Area Premier Nannies or the families to know about you:

I have answered the above questions in a honest manner and understand that if any of the information is false,
I may be disqualified for employment by Bay Area Premier Nannies.

Signature: Date:
FOR BAY AREA PREMIER NANNIES USE ONLY
Application received on: Reviewed by:
Comments:

Revised on 4/22/2010