Nanny Employment Application

Nanny Employment Application

Thank you for your interest in joining Five Star Companion Care. Please complete this application to tell us about your availability, childcare experience, qualifications, and references.
Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Apartment/Unit
City
State
ZIP Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Are you at least 18 years old?
Availability
Position Applying For

Other
Employment Desired
Date Available to Start

MonthDayYear
Date
Days Available
Preferred Shift Availability
Are you available on weekends?
Earliest Time Available to Start

Hour Minutes

AM/PM Option
Latest Time Available to Work Until

Hour Minutes

AM/PM Option
Are you willing to work in homes with pets?
Childcare Experience
For purposes of this application, childcare experience must be verifiable experience caring for children other than your own children or family members.
Do you have verifiable childcare experience caring for children other than your own children or family members?
How many years of verifiable childcare experience do you have?
Briefly describe your childcare experience, including the ages of the children and your primary responsibilities.
What age groups do you have experience caring for?
Which childcare duties do you have experience performing?

Other
Was your childcare experience primarily:
When did you most recently provide childcare?
Do you have experience caring for children with special needs?
If yes, briefly describe your experience caring for children with special needs.
Childcare Experience Verification
First Name
Last Name
Relationship to Applicant / How Do You Know This Person?
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How can this person verify your childcare experience?
Name of Family, Employer, Agency, or Organization
Additional Qualifications
Are you CPR certified?
Are you First Aid certified?
Do you have a valid driver's license?
Do you have reliable transportation?
Are you comfortable transporting children when authorized?
Do you speak any language(s) other than English?
Are you willing to complete and maintain all background checks, clearances, and health-screening requirements required by Five Star Companion Care?
Are you comfortable caring for more than one child at a time?
Are you willing and able to follow the parent/guardian's written instructions, household rules, routines, and emergency procedures while caring for children?
What other language(s) do you speak?
Employment History
Years Known
Enter whole years only
Employers
References
References must be verifiable professional, employment, childcare, or non-relative references. Family members may not be used as references.
1st Reference
First Name
Years Known
Enter whole years only
Last Name
Relationship to Applicant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Reference
First Name
Last Name
Relationship to Applicant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
3rd Reference
First Name
Last Name
Years Known
Enter whole years only
Relationship to Applicant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employment Eligibility
Are you legally authorized to work in the United States?
Are you willing to complete required employment background checks and clearances?
Applicant Certification & Acknowledgment

I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that providing false, misleading, or incomplete information may result in disqualification from employment consideration or termination of employment if hired. By submitting this application, I acknowledge that I have read, understand, and agree to the certification above.
Date

MonthDayYear
OFFICE USE ONLY – ADMINISTRATIVE REVIEW.
Application Reviewed By
Interview Date

MonthDayYear
Date
References Checked
References Checked By
Background/Clearances Reviewed
Date Hired

MonthDayYear
Date
Hire Approved By
Notes
Should be Empty:

Nanny Employment Application

Applicant Information

Availability

Childcare Experience

Childcare Experience Verification

Additional Qualifications

Employment History

References

Employment Eligibility

Applicant Certification & Acknowledgment

OFFICE USE ONLY – ADMINISTRATIVE REVIEW.