Date *

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Position(s) Applying For *

Check all that apply

Part-time Nanny

Full-time Nanny

Nanny-on-Call

Summer Nanny

Babysitter

Valid Drivers License *

Yes

No

Have You Had Any Accidents or Driving Violations? *

Yes

No

Did You Graduate High School? *

Yes

No

Are You Attending Any Post-Secondary School? *

Yes

No

What Age(s) Do You Have Experience With? *

Check all that apply

Newborn (0-6 months)

Infant (6 months - 12 months)

Toddler (1-2 years)

Preschool (3-5 years)

Gradeschool (6-12 years)

Teenager (13+ years)

What Type of Experience Do You Have? *

Please check all that apply

Private Babysitting (non-relatives)

Private Babysitting (only-relatives)

Daycare Center

Preschool

Church Nursery

Camp Counsellor

Nanny

Other

Comfortable with *

Please check all that apply

Drive/Transport children to/from activities

Overnight Care

Animals

Parents who work from home

Supervising Swimming

Light housekeeping

Caring for sick children

Meal prepping

Running light errands

Name

First Name

Last Name

Mobile Phone *

(###)

###

####

Other Phone *

(###)

###

####

Name *

First Name

Last Name

Mobile Phone *

(###)

###

####

Other Phone *

(###)

###

####

Name *

First Name

Last Name

Mobile Phone *

(###)

###

####

Other Phone *

(###)

###

####

Which of these do you currently have that are valid (less than 1 year old) requirements? *

Check all that apply

Child Abuse Check

Criminal Record Check with Vulnerable Sector Check

Standard CPR/First Aid Level C

Drivers Abstract Report

None

Other

Available Start Date *

MM

DD

YYYY

Days Available *

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Do you currently have an active profile on any Nanny job sites? *

Yes

No