Nanny, Doula and Caregiver Application

Name
Home Phone Number
Mobile Phone Number
Best Time to Call
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
License 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
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