Babysitter and Nanny Application Form
Name
*
First Name
Last Name
Personal Information
Birth Date
*
Please select a month
January
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Month
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Day
Please select a year
2026
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Year
Do you currently study?
*
No
Primary School
High School
University
Higher Degree
Major
What is your highest level of education completed?
*
Martial Status
*
Single
Married
What is your primary language?
*
Are you bilingual or fluent in another language? List Below or type "N/A"
Are you interested in babysitting or nanny opportunities? (select both options if both)
*
Baby sitting
Nanny
Available Start Date
-
Month
-
Day
Year
Date
What are your desired working hours?
*
What are working hours that you would consider?
*
Do you have reliable transportation?
*
Yes
No
Are you at least 18 years old?
*
Yes
No
Are you available for:
*
Part-time
Full-time
On-call or last minute care
Weekends
Overnights
Any Certificates? First Aid, CPR etc.
*
ex: child care, cooking, language or any
How many years of childcare or nanny experience do you have?
*
What ages of children have you worked with?
*
Infants (0-12months)
Toddlers (1-3 years)
Preschool (3-5 years)
Elementary (6-10 years)
Pre-teens/Teens (11+)
Do you have experience working with kids with special needs? If yes, please list below the disabilities.
Are you willing to take certification courses if needed?
*
Yes
No
Are you comfortable with:
*
Diapering and potty training?
Light meal prep for kids?
Driving children (if needed)?
Light housekeeping?
Do you have a valid Drivers License?
*
Yes
No
Are you willing to undergo a background check? (this is required to move forward in the interview process)
*
Yes
No
Are you legally authorized to work in the US?
*
Yes
No
Have you ever been convicted of a crime?
*
Yes
No
If yes, please explain.
Please list 2-3 references (preferably past families or employers) Include NAME, PHONE NUMBER, RELATIONSHIP, YEARS KNOWN
*
Contact Details
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Present Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
File Upload/ Resume Upload
*
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Please Describe more about your competence in these work experiences
*
Your daily activities with children, cooking, cleaning, etc.
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Please verify that you are human
*
Phone Number/ Email
469-420-0173 or Blushbloomnannyco@gmail.com
Signature
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