Dear Nanny,
Thank you for your interest with Nanny Brokers USA
We believe that your Career and prosperity and well being as a Nanny are just as important as the Clients we
work with.
To register with us, you MUST have:
*Be at least 21 yrs of Age or older
*At least (2) years of experience in Childcare
*Drive and have your own dependable car
*Have a valid drivers license , and current auto insurance
*Agree to a Background Check
*Have NO criminal history and a safe driving record
*Be certified in CPR/First Aide or be willing to obtain it within 30 days
*Be legal to work in the USA, Must have valid ID, passport, valid immigration card, or alien certificate
* Have a cell phone so we may contact you IMED if we have emergencies or available last min jobs.
Upon arriving to your interview Please make sure you have photo copies for us to keep of your Drivers License,
Social security card and/or passport and work visa
We look forward to working with you !!!
Sincerely,
Cheryl LaFleur Collins
Nanny Brokers Employment Application (Please print and fax to us, or email to us as a doc. )
Childcare/Elder Care Employment Application
Date________
Please check all that apply:
I am Seeking : FT Live Out____ PT Live Out____Live In___ 12hr Live in____24 hr Live In______
Day Temp_____ Afternoon Temp____ Evening Temp_____
Nanny____ Nanny/HouseKeeper_____Housekeeper___ Temp Sitter_____
New Mother /New Baby Care_____ Elderly Care___ Other______
Salary Desired Per Hour $______
Salary Desired Per Week $_______
I would like to Start by:_________
I would Like my Employer to with hold my taxes____
I would Like to report my own taxes______
Areas you would consider working in___________________________________________
( Please understand that in Atlanta, most jobs and driving distance is 30-45 mins on average)
Name_______________________________________________
Address________________________________________________________________
County you live in_______________________________
City_________________________________________State______________Zip_____
Home Phone___________________Cell#__________________Pgr#_______________
Education
Elementary School______________________________________Year From-To____
High School_____________________________________Year From____To____
Did you Graduate?______ Year______
College_______________________________________
_______________________________ From ____ To________ Did you Graduate?____
_______________________________ From ____ To________ Did you Graduate?____
_______________________________ From ____ To________ Did you Graduate?____
_______________________________ From ____ To________ Did you Graduate?____
Total years of childcare/elder Experience___________
Formal Education Yes ____ No ____
Some College Yes ____ No____
Total Years as a Nanny/Caregiver________ if less than 2 yrs, List other Caregiver related experience below.
________________________________________
I am CPR certified Yes_______ No________ I am willing to take a class_______
I am First Aide Certified Yes________ No________ I am willing to take a class_______
I will work In the following areas of
town:_______________________________________________________________________
I will relocate to any city for a Live in Position Yes___ No___ Depends______
(Optional Questions)
I am a US Citizen: Yes_____ No_______ Country I am From_________________
Age____Religion________
(Please check all that you are willing to do in a position)
I am willing to :
Drive___
Cook for the person in my care___Cook for the Family___
Will help with housework for the person in my care____
Help with housework for the Family___
Work evenings___Work weekends____Work with Pets_____
Commit to a One year assignment___
Sign a contract for the right Family____
Travel with the Family___
Relocate with the Family____
Drive to appts_____
I am able to assist with:
Teach reading/writing|___
Teach social skills___
Help with homework__
Swim with the children____
Play with the Children___
Transport ___ Dressing____ Feeding_____
I am interested in being a Caregiver because:________________________________________
I describe my personality as :__________________________________________________
My hobbies and special interests are:_________________________________________
My future goals are:________________________________________________________
.
Caregiver Work Experience
Below please list your related experience
-----------------------------------------------------------------------------------------------
1.Employer_________________________________Phone____________
Dates of employment started_____________ Until _________________
Reason you left this position?_________________________________________________
_______________________________________________________________________
Childrens/Elder ages_____________
Describe the work you preformed :
__________________________________________________________________________________________
____________________________________________________
Address________________________________________________________________
City________________________State__________Zip___________________________
----------------------------------------------------------------------------------------------------------------
2. Employer_________________________________Phone____________
Dates of employment started_____________ Until _________________
Reason you left this position?_________________________________________________
_______________________________________________________________________
Childrens/Elder ages_____________
Describe the work you preformed :____________________________________________
Address________________________________________________________________
City________________________State__________Zip___________________________
--------------------------------------------------------------------------------------------
3.Employer_________________________________Phone____________
Dates of employment started_____________ Until _________________
Reason you left this position?_________________________________________________
_______________________________________________________________________
Childrens/Elder ages_____________
Describe the work you preformed :____________________________________________
Address________________________________________________________________
City________________________State__________Zip___________________________
Non Related Experience
1.Employer_________________________________Phone____________
Dates of employment started_____________ Until _________________
Reason you left this position?_________________________________________________
_______________________________________________________________________
Job Title_____________________________
Describe the work you preformed :
__________________________________________________________________________________________
____________________________________________________
Address________________________________________________________________
City________________________State__________Zip___________________________
----------------------------------------------------------------------------------------------------------------
2.Employer_________________________________Phone____________
Dates of employment started_____________ Until _________________
Reason you left this position?_________________________________________________
_______________________________________________________________________
Job Title_____________________________
Describe the work you preformed :
__________________________________________________________________________________________
____________________________________________________
Address________________________________________________________________
City________________________State__________Zip___________________________
----------------------------------------------------------------------------------------------
3.Employer_________________________________Phone____________
Dates of employment started_____________ Until _________________
Reason you left this position?_________________________________________________
_______________________________________________________________________
Job Title_____________________________
Describe the work you preformed :
__________________________________________________________________________________________
____________________________________________________
Address________________________________________________________________
City________________________State__________Zip___________________________
Childcare Caregiver Questionnaire
Caregivers Name_____________________________________
Address_________________________________City__________ State____ Zip_______ Home
Phone__________
**Please answer the questions below, please choose only (1) answer for multiple choice questions..
1. I want to be a Childcare provider because?_____________________________________________
2. I have had at least 2 years childcare experience Yes______ No_______
3. My favorite age child to care for is ____________________
4. The youngest child other than my own I have cared for was _____ I am most comfortable with ________ ages
5. I am CPR trained Yes____ No ____ Willing to get_____
6. I am First Aide certified Yes ____ No____Willing to get_____
7. I am willing to keep _______ children at one time
8. I like Pets Yes ______ No____
9. I am willing to do housekeeping related to the children Yes_____ No_____
10. I am willing to do housekeeping for the family on occasion Yes____ No______
11. I am willing to travel with the family Yes_____ No______ Not able too_____
12. I am willing to make a one year commitment with one family as long as we work well together
Yes____ No___ If No please explain why_________________________________
13. Gates should NOT be placed in this area of the home due to it breaking free an the child falling down the
stairs ?________________
14. These type products should be kept up an out of a child's reach _____________________________
15. My typical day with Toddler would be ______________________________________________
_________________________________________________________________________________
16. Small toys should be used only during these times____________________________________
17. Small children diet should consist of the
following_______________________________________________________
18. If a child in my care is injured I would call _______________________ then___________________
19. If a small baby or child in my care cries for several hours non stop I would:
_________________________________________________________________________________________
20. It is suggested by Medical Professionals that small children not eat the following due to choking hazards :
_____________________________________________________________________________________
21. If the Phone rings when I am bathing a small infant or Toddler, I would :
______________________________________________________________________________________
23. A newborn or small infant Infant has to be ____________ during and or after each feeding
24. If a infant isn't breast fed typically they are fed _____________
25 By ___________________ an infant violently has been known to injure or even kill some infants.
26. If a child in my care don't listen of follow directions i would discipline them by :_____________________
___________________________________________________________________________________
27. I enjoy these child hood activities ___________________________________________________
28. When transporting a small child in my car , I would place the car seat in what position?__________________
29. I would administer Medication to a child when__________________________________________
_________________________________________________________________________________
30. I think it is OK for a child to "pitch a fit " Yes_______ No______ If No why?______________________
31. If a child in my care does pitch a fit of raging anger, I would _________________________________
__________________________________________________________________________________
32. I feel it is OK for me to take a nap while the child sleeps Yes________ No______
33. I feel it is OK to watch TV while the children are napping as long as it is OK with the parents? Yes_____
No_____
34. I like to bring my own lunch? Yes___ No____ I prefer to eat what the children eat
35. I feel like it is OK to leave a child for a few minutes while I go into a store and pay for my gas? Yes___ No___
36. I feel it is OK to let a child cry for a while in their crib? Yes___ No_____If yes how long?_________________
37. I think it's OK to "prop" up a babies bottle while I am doing something else? Yes____ No____ if Yes, Please
explain
_________________________________________________________________________
38. I think a baby needs to be changed when they have a soiled diaper Yes____ No____ if NO
explain_____________
______________________________________________________
39. I think that it is OK to leave a baby in a swing for several hours as long as the baby is not crying? Yes____
No____
if Yes explain__________________________________________________________________
40. I feel it very important to wash my hands before and after changing a diaper? Yes___ No____
41 Would you allow a child to go to sleep after a bump to the
head?________________________________________
42. What type discipline do you
use?_________________________________________________________________
43.What would you do if the child you were caring for did not come home from
school?____________________________
__________________________________________________________________________________________
_______
44. What type activities would you do with a school age
child?_________________________________________________
45. What is the most important to you about a
Family?________________________________________________________
I sometimes am depressed Yes______ No_______
. For times I am depressed i take this medication__________________ how many times per day_____
. When I am depressed I sometimes like to walk by myself to re- group my thoughts Yes______ No _____
. My favorite Music is?_____________________
. My favorite Musical Group or band is________________________________
. I feel I was raised in a ________________ home
. I feel the discipline i received from ____________________________ was ______________________
. Do you feel you were ever abused mentally, physically, emotionally as a child or an adult? Yes___ No___
If Yes please explain_______________________________________________
. Have you ever had thoughts of suicide? Yes____ No ______ If Yes explain___________________
_________________________________________________________________________________
. I often have thoughts of running away from it all ? Yes_____ No______ If Yes explain __________________
. Please describe the relationship with your parents or siblings: ______________________________________
. I sometimes have thoughts of hurting myself or others Yes_____ No______
If Yes explain_______________________________________________________________________
. I feel I am a loving and compassionate Person Yes________ No________
If No explain why____________________________________________________________________
. My long term goals are to ________________________________________________
. My friends describe my personality as: _________________________________________________________
I am comfortable in large crowds Yes______ No_____________
. I feel it is OK to spank a child? _______ if yes, in which situations?_______________________
. I am OK with being on video, while working in a home ? yes______ no_____ If no why?____________________
_________________________________________________________________________________
. I am only working as a Nanny/ Caregiver because I cant find work anywhere else? Yes____ No_____
Sinature_____________________________________Date__________________________