Nanny Intake Form

Full Name

Age (must be 18+)

Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Preferred Method of Contact

Address or Neighborhood

Do you have a valid drivers license?

Do you have reliable transportation?

Vehicle make, model and year.

Do you have a clean driving record?

If no, explain

Are you willing to transport children?

How many years of nanny/childcare experience do you have?

What ages do you have experience caring for? (check all that apply)

Do you have experience with special needs?

If yes, explain briefly.

Do you have experience with multiples?

If yes, explain.

Are you CPR certified?

Are you First Aid certified?

What is your highest level of education?

Do you have any other relevant certifications?

If yes, explain.

What kind of position are you seeking?

What is your desired hourly/weekly rate? (its ok to give a range)

Are you comfortable with pets/pet care?

if no, explain.

Are you comfortable with light housekeeping/housework?

Are you authorized to work in the U.S.?

If no, explain.

Do you authorize MamaByrd Nanny Placements LLC to perform a background check on you? (at no cost to you)

If no, why?

Write a bio describing your experience (be thorough). What makes you a great nanny? What are some of your interests outside of work?

How did you hear about MamaByrd Nanny Placements LLC? (select all that apply)

Other

Thank you for filling out our intake form. We'll review your information and be in touch within 1-2 days to schedule an initial phone interview. MamaByrd supports nanny moms in finding roles that honor both their caregiving strengths and their needs as parents.