There are 3 ways to contact us: Fill out our on-line form (see below). Call 1-800-262-8771. Print our on-line application or download our PDF version and fax it to 1-617-969-1269. If you need Adobe Acrobat Reader, click here. If you have any questions you can reach us by phone on 1-800-262-8771 or E-Mail at info@AmericanNannyCompany.com.

Nanny Employment Application

First Name
Last Name
Current Address
City
State	Zip
Phone
Best Time To Call
Permanent Address
City
State	Zip
Permanent Phone
Best Time To Call
Fax
E-mail
SocialSecurity No.
Date Of Birth
Weekly Salary Desired
Available To Begin Work
Live In	Live Out

How Did You Hear About American Nanny Company?
	Web Search Referral Newspaper
If you found us from a web search engine, which one was it?
	Friend Print Ad Alta Vista All The Web Ask Jeeves AOL's Search Direct Hit Excite Galaxy Go Google GoTo HotBot Jayde Look Smart Lycos Magellan MSN Northern Light Starting Point Web Crawler Yahoo Other
Where would you like to be placed?
1st Choice
2nd Choice
3rd Choice
EDUCATION
Name &Location Of School Years Attended Year Graduated Degree Major Subjects High School Yes No Pending College Yes No Pending Special Training Yes No Pending
EMPLOYMENT HISTORY
Dates From To Employer Address Phone Position Held
What age child do you most enjoy working with? Least enjoy?
What activities do you enjoy doing with children?
Why do you want to be a nanny?
What are your future plans?
Can you make a 1 year commitment? Yes No
Can you stay longer? Yes No
REFERENCES Please list five names, make sure that at least two relate to child care experiences, other than relatives.
Name Address Phone Position Held Live In Nanny Live Out Nanny House Keeper Baby Sitter Other Live In Nanny Live Out Nanny House Keeper Baby Sitter Live In Nanny Live Out Nanny House Keeper Baby Sitter Other Live In Nanny Live Out Nanny House Keeper Baby Sitter Other Live In Nanny Live Out Nanny House Keeper Baby Sitter Other
MEDICAL INFORMATION
How would you rate your overall health?
	Excellent Good Fair Poor
Do you smoke?	Yes No
Are you allergic to?	Cats Dogs
Do you have a driver's license? Yes No
Can you operate a stick-shift car? Yes No
Do you own a car?	Yes No -- If yes will you bring the car with you? Yes No.
Do you swim?	Yes No
	Life-Saving Training CPR Training First Aid Training
Aside from parking tickets, have you ever been arrested or convicted of a felony or misdemeanor? Yes No
On a scale of 1 to10(10 being highest), please rate the following as honestly as possible
Ability to be a self starter 1 2 3 4 5 6 7 8 9 10 Control of temper 1 2 3 4 5 6 7 8 9 10 Sense of humor 1 2 3 4 5 6 7 8 9 10 Ability to follow directions 1 2 3 4 5 6 7 8 9 10 Patience 1 2 3 4 5 6 7 8 9 10 Honesty 1 2 3 4 5 6 7 8 9 10 Common sense 1 2 3 4 5 6 7 8 9 10 Neatness 1 2 3 4 5 6 7 8 9 10 Ability to make friends 1 2 3 4 5 6 7 8 9 10 Maturity 1 2 3 4 5 6 7 8 9 10 Ability to speak up when something bothers you 1 2 3 4 5 6 7 8 9 10
Comments and/or List Nanny Positions you are interested in from our "On-line Jobs".