Nanny Application Form

Security Information

Thank you for taking the time to complete this application. Before you begin, you may want to print a blank copy of the application as a safeguard in the event that you run into any problems with your computer during the process. The application may take as long as 45 minutes to complete and some nannies have informed us that their internet provider has "timed them out" prior to completing it. Should that occur, you can complete the application hard-copy and mail it to us at: Professional Nanny Online, 46 West Central St., Natick, Ma. 01760. We look forward to helping you find a job you'll love!

When you have finished completing this form, be sure to press the "Submit" button. Thanks


To complete an On-Line Training Application ONLY, Please Click Here.
Otherwise, complete the following application in full!

Note: All required fields are highlighted in blue!
Please do NOT use all CAPITAL LETTERS!

Last Name:
First Name:
MI:
Street Address:
 City, State & ZipCode:
Telephone (Days):
 Telephone (Evenings):
Social Security #:
Citizenship:
 Sex:
Emergency Contact #1:
(Name, Address, Phone)
 Date Available to Start:
Year: Month: Day:
Emergency Contact #2:
(Name, Address, Phone)
 Your Date of Birth:
Year: Month: Day:
E-mail address:
(ex. user@aol.com)
 Fax Number:
(optional)
CommuteTime:
 Area/State You Wish To Work:
How Did You Hear Of Us?
 Cell-Phone/Pager Number:
(optional)
Do you wish to participate in
our On-Line Training Program?

Call our office at (508) 650-8889 for
details and more information.

Section A

How many children are you comfortable working with:
Are you accessible to the T (MA only):
Do you smoke?
Do you have experience at a daycare?
Do you have experience as a Nanny?
Do you have a good work history?
Do you have 1 year of Child-Care Experience?
Do you have Infant child-care experience:
Do you have Toddler child-care experience:
Do you have Pre-school child-care experience:
Do you have School-age children experience:

Do you prefer FT or PT:
Which do you prefer, Live-In or Live-Out:
If you chose Live-In, what is your pay range:
If you chose Live-Out, what is your pay range:
Do you use a Nickname:
Do you drive a Car:
Do you have a criminal record?
Do you have a good driving record?
Do you own your own car?
Are you able to drive a standard?
Do you have swimming ability?
Are you a High school grad/GED?
Any education after High school?
Do you have CPR Certification?
Do you have First-Responder Certification?
Do you have any children of your own:
Length of service committment:
Do you need to bring your own child:
What is your hair color:
What is your eye color:


Availability Schedule

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Hours:
Hours:
Hours:
Hours:
Hours:
Hours:
Hours:



In the fields below, please provide an explanation if any of these situations apply to you:
Motor vehicle infractions, any loss of license or non-moving violations.
If you were employed less than one year at your last two jobs.
If you have left any job on un-friendly terms.
Please explain any gap in your employment history.


In addition to child-care duties, families may request some other household tasks. Please indicate which tasks you are willing to perform:
Laundry Grocery Shopping Driving Errands
Dusting Vacuuming Bathrooms Family Meal Prep


Do you like pets? Would you be comfortable in a home w/pets?
Please indicate any specific kinds of pets you would not be comfortable working with:


Have you considered one or more of the following careers:
Social Work Nanny Teaching Police Work
Nursing Day-Care Sales Ministry


When caring for children there are a number of activities that require your attention. Please rate the following activities:
(1 for Most Enjoyable and 5 for Least Enjoyable)
Reading to children Watching TV Arts & crafts
General supervision Outdoor play Bathing
Feeding Dressing children Cooking
Board games Day trips Family outings
Tidying up after children Make believe games


Section B
Child Care Experience

Please list each employer, Start with most recent first:

Family or Company Name: From: To:
Address: City: State, Zip Code:
Telephone:
Ages of children:
Please Indicate your Responsibilities as related to this job:
feeding meal clean-up bathing meal prep
car-pool grocery-shopping laundry errands
homework help overnight care reading games
plan activities special projects driving other
Please briefly explain your reason for leaving:

Family or Company Name: From: To:
Address: City: State, Zip Code:
Telephone:
Ages of children:
Please Indicate your Responsibilities as related to this job:
feeding meal clean-up bathing meal prep
car-pool grocery-shopping laundry errands
homework help overnight care reading games
plan activities special projects driving other
Please briefly explain your reason for leaving:

Family or Company Name: From: To:
Address: City: State, Zip Code:
Telephone:
Ages of children:
Please Indicate your Responsibilities as related to this job:
feeding meal clean-up bathing meal prep
car-pool grocery-shopping laundry errands
homework help overnight care reading games
plan activities special projects driving other
Please briefly explain your reason for leaving:

Family or Company Name: From: To:
Address: City: State, Zip Code:
Telephone:
Ages of children:
Please Indicate your Responsibilities as related to this job:
feeding meal clean-up bathing meal prep
car-pool grocery-shopping laundry errands
homework help overnight care reading games
plan activities special projects driving other
Please briefly explain your reason for leaving:

Family or Company Name: From: To:
Address: City: State, Zip Code:
Telephone:
Ages of children:
Please Indicate your Responsibilities as related to this job:
feeding meal clean-up bathing meal prep
car-pool grocery-shopping laundry errands
homework help overnight care reading games
plan activities special projects driving other
Please briefly explain your reason for leaving:

Family or Company Name: From: To:
Address: City: State, Zip Code:
Telephone:
Ages of children:
Please Indicate your Responsibilities as related to this job:
feeding meal clean-up bathing meal prep
car-pool grocery-shopping laundry errands
homework help overnight care reading games
plan activities special projects driving other
Please briefly explain your reason for leaving:

Section C
Non-childcare employment

Begin with most recent, list all non-child care work:

Company Name: From: To:
Address: City: State, Zip Code:
Telephone Numbers:
Contact Name:
Please indicate your responsibilities as related to this job:

Company Name: From: To:
Address: City: State, Zip Code:
Telephone Numbers:
Contact Name:
Please indicate your responsibilities as related to this job:

Company Name: From: To:
Address: City: State, Zip Code:
Telephone Numbers:
Contact Name:
Please indicate your responsibilities as related to this job:

Company Name: From: To:
Address: City: State, Zip Code:
Telephone Numbers:
Contact Name:
Please indicate your responsibilities as related to this job:

Section D
Personal Overview

Please do NOT use all CAPITAL LETTERS!
Also, DO NOT USE the "Return" or "Enter" keys at the end of each line.
Only use the "Return" or "Enter" keys for a paragraph break.

1) Please describe your family:

2) Please tell us how the child you care for will benefit from having you as their Nanny:

3) Please tell us how your friends might describe you:

4) Please tell us how you might respond in a stressful situation:

5) Please describe your strengths and any creative hobbies you will bring to your job:

6) Finally, Please tell us why you would like to be employed as a Nanny:

Section E
Educational Background

School Attended:
Address: Course of Study:
From: To: Did you graduate?: Degree:

School Attended:
Address: Course of Study:
From: To: Did you graduate?: Degree:

School Attended:
Address: Course of Study:
From: To: Did you graduate?: Degree:

School Attended:
Address: Course of Study:
From: To: Did you graduate?: Degree:

Section F
Hobbies/Interests/Volunteer Work

In the space provided, please list any volunteer work, hobbies, or interests that you may have.
(This need not be related to child care, anything such as human services, nurses aid, etc. may be included).


Section H
Health Information

Do you suffer from any allergies, if yes provide details:
Do you have any health problems which could possibly interfere with your position, if yes provide details:
Do you have a regular Physician, if yes provide details:
Are you presently under the care of a doctor, if yes provide details:
Are you presently taking any medications or prescriptions, if yes provide details:
Have you any Alcohol/Drug illnesses in the past year, if yes provide details:
Will you require a health contribution from your employer:



By Clicking on submit below, and continuing this application process, you fully acknowledge and agree to the following agreement:

PURPOSE
The Agency has designed and developed a system of interviewing, selecting, training, and placing individual in-home child care providers (nannies) with client families, who are also carefully selected and screened. The Agency strives to provide services in a conscientious manner according to carefully established guidelines. To include selecting only nannies who recognize, value and agree to participate in the Professional Nanny Training Program.
The Agency wishes to place the Nanny with a family and the Nanny wishes and has requested such placement. The nanny wishes to make a one year commitment to a family/client and in order to do so, it is necessary for the Nanny to cooperate fully and fairly & to provide all necessary information in a timely way.

PERSONAL INFORMATION
As part of it's placement system the Agency requires Nanny applicants to complete various forms, including admission forms, questionnaires and the like. The Nanny, by clicking on submit below, herein stated that she has been COMPLETELY HONEST, FRANK AND THROUGH IN PROVIDING INFORMATION, and further, that she/he does not know of any information, or condition whatsoever, including, but not limited to; criminal history, family history, medical history, or emotional conditions which have not been revealed to the Agency in writing, including anything a reasonable person might consider undesirable in a Nanny providing in-home, unsupervised care for a child. It is further understood that the Agency may determine at any time that a nanny is unsuitable for caring for children and reserves the right to remove the Nanny from placement and training program, at it's sole discretion without recourse to the Nanny. By clicking on submit below, Nanny gives permission to the Agency and acknowledges that the Agency will; verbally verify references, verify that the Nanny does not have a criminal record of any kind, verify that the Nanny does not have any health or medical conditions which would put a child, or a client of the Agency at risk, in any way. and will obtain a copy of the Nanny's driving record to be certain that the Nanny is a safe driver. Therefore, the NANNY BY CLICKING ON SUBMIT BELOW ASSURES THE AGENCY THAT ALL INFORMATION WHICH MAY IMPACT ON THE NANNY'S EMPLOYABILITY HAS BEEN DIVULGED Further, Nanny understands that any and all information provided to the Agency, either orally, or in writing will be shared with client families interested in employing the Nanny. By clicking on submit below, the Nanny grants permission to the Agency to conduct this thorough background check. The Nanny assures the Agency that all requested documentation e.g. references, copy of driving record, etc. will be provided to the Agency in a timely manner and further, should the Nanny accept a position with one of the Agency's clients prior to providing the Agency with all of the required documentation, the Nanny agrees that any payment of salary due to her may he postponed until the required documentation has been submitted.

INDEMNITY
The Agency and/or it's representatives do not employ, exercise control or discretion over client families and disclaims all responsibilities for conduct or omissions of the client family. The Nanny shall hold the Agency and/or its representatives harmless against any damages and liability whatsoever arising out of, or in way in connection with the employment of the Nanny introduced to the Nanny by the Agency, or any of it's representatives, regardless of how, when, or where damages or liability was incurred. Further, Nanny agrees that any claim or controversy arising out of, or in relation to this contract, or breach thereof, shall be settled by arbitration in Boston, in accordance with the rules of the American Arbitration Association and judgment upon the award rendered by the Arbitrator(s) may be entered into any court having jurisdiction thereof.

PROFESSIONAL NANNY TRAINING PROGRAM
The training & in service educational program is offered at no cost to nannies placed through Professional Nanny. By clicking on submit below, the Nanny agrees that she/he recognizes the value of providing safe, nurturing, standardized, high-quality care to children and therefore agrees to attend the Certification Program for nannies offered by Professional Nanny. It is understood that, without exception, ALL NANNY APPLICANTS MUST BE WILLING TO ATTEND THE CERTIFICATION PROGRAM IN ORDER FOR THE AGENCY TO CONSIDER THE NANNY FOR PLACEMENT. Willingness to participate is considered to be an indication that the nanny is committed to providing the highest quality of care to the children in her charge. The nanny hereby agrees to attend and fully participate in the training offered. Segments of the training may include classroom discussion, demonstration, on line training, on line testing & parental on line supervision / communication. The Nanny acknowledges and agrees to participate in the training as provided by Professional Nanny.
Professional Nanny organizes an annual Awards Ceremony for nannies who have completed the Certification Program and awards grants to nannies based on the Nanny's performance in the training program. Professional Nanny also recommends to nanny employers that they bonus the nanny upon the Nanny's completion of the training. Certificates of completion for each area of the Professional Nanny Training Program are also provided to the Nanny, once work in each area is completed satisfactorily. Copies of Certificates are available to the Nanny's future employers and/or any educational institutions which the Nanny may request copies be sent.

DIRECT PLACEMENT
The agency has experienced situations whereby a family will offer the nanny a position and request that the nanny not divulge this information to the agency, in order for the family to avoid having to pay the placement fee. By clicking on submit below, the Nanny acknowledges and agrees not to engage in any unfair or deceptive, or dishonest practices against the agency, and to report any such offers to the agency immediately. Further, it is understood and agreed that the agency utilizes a full time Private Investigator to protect the agency against any such deceptive practices. The Nanny further agrees that she/he will pay the agency fee on behalf of any client should the agency discover that any deceptive or dishonest activity has taken place between a family and a nanny introduced by the agency, or should the Nanny continue to remain in the employ of any family who does not pay the agency fee. This includes occasional baby-sitting, residing with the family, referring others to the family, or other instances whereby the agency is not paid for services provided to the family. After two years of the initial introduction of the nanny & the family by the agency, the parties are no longer restricted by this agreement.

TECHNICAL PARENT SUPERVISION
By clicking on submit below the nanny gives her permission for the family to utilize technology which allows the parent to see and talk with their child(ren) and the Nanny during the day from another location.

COMMUNICATION
The Nanny applicant agrees to communicate daily, as necessary with the agency during the interview process, and to report all offers of employment to the agency immediately.

ENTIRE AGREEMENT
This document represents the entire agreement between the Nanny & the Agency. Should any part of this agreement be deemed unlawful for any reason, the remainder of this agreement shall remain in full force and effect.