www.affordablenanny.com

Nanny or Caregiver Application

First Name
Middle Name
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Country
Daytime Phone	() -
Evening Phone	() -
Fax	() -
E-mail Address
Date of Birth
Number of Children
Allergies
Medical Concerns
Do you Smoke
Do you Drink
Do you Swim
Drivers License
Hobbies
Highest Level of Education Achieved
Did you Take any Type of Health /Nursing/Medical related Courses
If yes, please specify
Have you ever taken any First Aid or CPR Lesson
Knowledge in English
Recent Employers Name
Address
Position
Duties
Reason for Leaving
2. Employer Name
Address-
Position-
Duties-
Max. Number of Children you can take care.
Willing to work for Single Parent.
What are you confortable doing as a nanny?
What is Your Expected Salary?
Comment:

WELCOME to Affordable Nannies Referral Agency, Inc.