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
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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)
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-time and part-time nannies)
Back-up Care(back-up care/occasional sitting)
Temporary Placements (short-term- 3-9 months)
Summer Placements (June- August)
Church Care (Sundays)
What's the earliest date you can start?*
*
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.
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*
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