We are the leading placement agency since 1995 serving Ohio, Indiana, and Kentucky!

You’re the heart
of our business

  

Contact Us

513-661-4245
Cell: 513-702-2396
Fax: 513 661 4277
ruth.hatfield@nannyplaceohio.com

Caregiver Application

Section 1: Personal Info
Date (mm/dd/yy)  
First Name Last Name
Middle Name Maiden Name
Address Line 1  
Address Line 2  
City State
Zip Code Part of Town
Email Address    
Day Phone Evening Phone
Cellphone Over 21?
       
Section 2: Education      
High School Name
City
 State
Dates Attended From
to
Graduate
College Name
City
 State
Dates Attended From
 to
Graduate
Other Education
City
 State
Dates Attended From
 to
Graduate
 
Describe any other type of service or training that was childcare related
Describe child related volunteer work
Describe non-child related volunteer work
Do you plan to further your education? Please explain
 
Section 3: Nanny Placement Service Questionnaire
When are you available to start work?  (mm/dd/yyyy)
What hours are you available to work?
Do you have any other commitments we should know about?
If all goes well, would you be willing to renew your contract with the family after a year?
Describe your previous experience with children: How has that helped you prepare for a job like this?
Would you be willing to do the following (if applicable):
Preparing Meals
Light Housekeeping
Laundry
Grocery Errands
Running Errands
Other
Would you work in a house with pets?
Do you smoke?
Can you swim?
Would you be willing to accompany a family on vacation if needed?
Does your family support your decision to become a nanny?
Do you speak any foreign languages? If so, which ones?
What interests you most about a nanny job?
What interests you least?
Do you have a car?  Make / Model / Year
Are you insured?
Do you need health insurance?
Will you be getting health insurance on your own?
What salary range do you expect?  
Do you need taxes filed to prove your income?
 
Please check all you are experience working with:
Special Needs
Multiples (twins, triplets, etc.)
Infants as young as 3 weeks
Toddlers
Pre-K
School-age
Night Nursing
If you have experience working with special needs, please explain
 
Section 4: General Information
Marital Status
Do you have children? If Yes, what ages?
Please check all the following that apply:
Take children to work?
Smoker?
Do you drive?
Are you insured?
CPR Certified?
First Aid training?
Own your own car?
Driving violations?
Do you have any physical limitations that could affect your work?
If Yes, please explain
Please list all athletic abilities or knowledge that can be taught to children
 
Do you have a criminal record?
If yes, please explain
 
Are you involved in any psychological treatment?
Do you have any allergies?
If yes, please explain
 
Would you be willing to do household duties?
If yes, please list
 
Is there an age group that you will not work with?
If yes, please list
 
Why did you choose a nanny career?
 
Please list any hobbies or interests
 
Please list any organizations you belong to
 
What are your strongest points in working with children?
 
What are your weakest points in working with children?
 
What is your approach to child rearing?
 
Please list types of discipline you use
 
Can you commit to a full year of employment?
If no, how long can you commit?
 
Briefly describe what your childhood was like and what types of things were important to your family
 
What is your overall view of children?
 
Section 5: Work Schedule
Please check all that apply regarding your work schedule
Full Time
Part Time
Live In
Live Out
Week
Overnight
Ongoing
 
Please list preferred areas to work
1.
2.
3.
4.
 
Are you willing to relocate?
 
Date available to start (mm/dd/yy)
 
Available schedule - Please put your most consistent schedule needed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
 
Section 6: Employment History
Employer 1:
Employer Name
Address
Phone Number
Supervisor Name
Your Position
Reason for leaving
   
Dates Worked  
From(mm/dd/yy)
To (mm/dd/yy)
 
Employer 2:
Employer Name
Address
Phone Number
Supervisor Name
Your Position
Reason for leaving
   
Dates Worked  
From(mm/dd/yy)
To (mm/dd/yy)
 
Employer 3:
Employer Name
Address
Phone Number
Supervisor Name
Your Position
Reason for leaving
   
Dates Worked  
From(mm/dd/yy)
To (mm/dd/yy)
 
Section 7: Child Care References
1. Name/Occupation
    Address
    Day Phone/ Evening Phone
   
2. Name/Occupation
    Address
    Day Phone/ Evening Phone
   
2. Name/Occupation
    Address
    Day Phone/ Evening Phone
 
According to the application material I have read, the above information has been filled out accurately and to the best of my knowledge.

As a nanny place by Nanny Placement Service, Inc., I will not begin employment until the family has satisfied payment for the services of Nanny Placement Services, Inc.
 
Type Your Full Name
Today's Date (mm/dd/yy)
 
Are you willing to provide a statement from your doctor stating that you are mentally and physically able to work as a caregiver?