Nanny, Doula and Caregiver Application

"*" indicates required fields

Name

Home Phone Number

Best Time to Call

Mobile Phone Number

Street Address

City

State

ZIP

Email Address*

Desired length of employment

Date Available

Position Desired

Are you currently employed?

Please indicate the hours you are available for work:

Are you willing to use your own vehicle?

Please indicate if you are willing to drive the children to the following:

What is your desired salary range?

Monthly / Weekly / Hourly

Housework duties you are willing to perform?

Meals you are wiling to prepare?

Do you mind if the family has an animal?

Are you willing to care for the animal?

Are you trustlined?

CPR Certified

CPR Expiration Date

TB Test

TB Test Expiration Date

Valid Driver's License

Licence Expiration

License Number

State

Insurance?

Insurance Policy Number

Passport?

Passport Number

Early Childhood Courses (completed)

Please include College, Course title, Grade and Date Completed

Early Childhood Courses Currently Enrolled In

Please include college, course title, units and completion date

Childcare employment history (starting with most recent)

Please include the employer name, address, phone number, children's ages, dates you start and left, your reason for leaving and leaving salary

Please indicate areas of experience

Transportation

Bottle Preparation

Clothing

Diapers

Bathing

Feeding

Reading

Tutoring

All of the above

Please provide two character references (work, school, religious, community):

Please include the reference name, relationship to you, and phone number.

Please write a short autobiography

Describe yourself, your interests, talents, school activities, and theories on how children should be treated and disciplined. What role will you as a nanny play in the lives of the children you are caring for? (This autobiography will be shared with the potential family)

May we contact your present employer?

Upload a photo of yourself

Max. file size: 100 MB.

By clicking Submit I agree that I have completed this application as accurately and precisely as possible. I also have read and agree to the terms in the Nanny, Doula, Caregiver practice Agreement. I understand that any of the aforementioned references and/or employers can and will be contacted for verification of this information, and I understand I may be subject to a background check in addition to Trustline.

Name and Date

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