Caregiver Inquiry Form
Welcome to Nanny Match! We look forward to supporting you on your journey as a caregiver. As this is the first step in our recruitment process, we kindly ask that you complete the form in its entirety. After completing the form, a member of our team will contact you within 24 hours to schedule your phone interview. We can't wait to meet you!
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you legally authorized to work in the United States?
*
Yes
No
Are you currently 21 years of age or older?
*
Yes
No
Do you reside in the state of Pennsylvania or plan to relocate within the next 3 months?
*
Yes
No
Do you hold a High School Diploma or Equivalent?
*
Yes
No
Do you have at least three years of experience as a childcare provider (outside of your family and friends)?
*
Yes
No
Which age group of children do you have the most experience with? Select all that apply.
Infant (Birth- Age 1)
Toddler (Ages 1-3)
Preschool (Ages 3-5)
Middle Childhood (Ages 6-11)
Young Teenager (Ages 12-14)
Teenager (Ages 15-17)
Which position are you applying for?
(If applicable, please list the job title, Indeed posting, or location)
Is this your first time working as a Nanny?
*
Yes
No
Is this your first time working with a Nanny Agency?
*
Yes
No
Do you agree to cooperate with us in a thorough background investigation (these searches may include a motor vehicle report, employment and criminal background check)?
*
Yes
No
Are you willing to be paid legally, or "on the books" as a W-2 employee?
*
Yes
No
Have you ever been convicted of a crime?
*
Yes
No
Have you or will you receive the COVID-19 vaccination?
*
Yes
No
Do you have a valid Driver's License?
*
Yes
No
Is your Driver's License currently restricted, suspended or expired?
*
Yes
No
Are you a smoker?
*
Yes
No
Do you hold a valid CPR license?
*
Yes
No
Which position(s) would you like to be considered for?
*
Long-Term Placements (Full/Part-Time, 1 Year or More)
Temporary Placements (Recurring Monthly – Up to 9 Months)
Commuter Companion (Before School: 6:30–9:00 a.m.)
Commuter Companion (After School: 3:00–6:30 p.m.)
Commuter Companion (Full Day Support: 6:30 a.m.–6:30 p.m.)
Back-Up Care (One-Time Daily Coverage)
Overnight Care
Summer Placement
Church Care Placement
Church Care (Sundays)
What's the earliest date you can start?*
*
Which position are you applying for? (If applicable)
What days and times are you available?
*
From
To
Note
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How did you hear about us?
*
If selected, would you like to be added to our back-up care list?
*
Yes
No
Reference 1:
*
Enter the name, phone number, email address, and relationship to this reference.
Reference 2:
*
Enter the name, phone number, email address, and relationship to this reference.
Reference 3:
Enter the name, phone number, email address, and relationship to this reference.
Resume
*
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