APPLICATION

Date *

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Position(s) Applying For *

Check all that apply

Part-time Nanny

Full-time Nanny

Nanny-on-Call

Summer Nanny

Babysitter

Valid Drivers License *

Yes

No

Have You Had Any Accidents or Driving Violations? *

Yes

No

Did You Graduate High School? *

Yes

No

Are You Attending Any Post-Secondary School? *

Yes

No

What Age(s) Do You Have Experience With? *

Check all that apply

Newborn (0-6 months)

Infant (6 months - 12 months)

Toddler (1-2 years)

Preschool (3-5 years)

Gradeschool (6-12 years)

Teenager (13+ years)

What Type of Experience Do You Have? *

Please check all that apply

Private Babysitting (non-relatives)

Private Babysitting (only-relatives)

Daycare Center

Preschool

Church Nursery

Camp Counsellor

Nanny

Other

Willing to: *

Please check all that apply

Drive/Transport children to/from activities

Overnight Care

Comfortable with Animals

Comfortable with Parents who from from home

Able to Swim

Comfortable with light housekeeping

Comfortable caring for sick children

Comfortable with meal prepping

Comfortable running light errands

Name

First Name

Last Name

Mobile Phone *

(###)

###

####

Other Phone *

(###)

###

####

Name *

First Name

Last Name

Mobile Phone *

(###)

###

####

Other Phone *

(###)

###

####

Name *

First Name

Last Name

Mobile Phone *

(###)

###

####

Other Phone *

(###)

###

####

Which of these do you currently have that are valid (less than 1 year old) requirements? *

Check all that apply

Child Abuse Check

Criminal Record Check with Vulnerable Sector Check

Standard CPR/First Aid Level C

None

Other

Available Start Date *

MM

DD

YYYY

Days Available *

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday