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American Nanny Company >> Nannies and Caregivers >> Caregiver Employment Application


There are 2 ways to contact us:
  1. Fill out our on-line form (see below).
  2. Call 1-800-262-8771.
If you have any questions you can reach us by phone on 1-800-262-8771 or E-Mail at info@AmericanNannyrCompany.com.

Caregiver Employment Application

First Name
Last Name
Current Address
City
State
Zip Code
Phone
Best Time To Call

Permanent Address
City
State
Zip Code
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
Full-Time    Part-Time
Permanent    Temporary
Please list days and hours available to work


How Did You Hear About American Nanny Company?
If you found us from a web search engine, which one was it?
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
College
Special Training
EMPLOYMENT HISTORY
Dates
From- To		 Employer Address Phone Position Held
 
Why do you want to be a Caregiver?
What are your future plans?
Can you make a 1 year commitment?
Can you stay longer?
REFERENCES Please list five names, make sure that at least two relate to caregiver experiences, other than relatives.
Name Address Phone Position Held
MEDICAL INFORMATION
How would you rate your overall health?
Excellent
Good
Fair
Poor
Do you smoke?
Yes No
Are you allergic to?
Cats Dogs
Which of these follow-up Services will you provide?

Good
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 Control of temper
Sense of humor Ability to follow directions
Patience Honesty
Common sense Neatness
Ability to make friends Maturity
Ability to speak up when something bothers you
Comments and/or List Caregiver Positions you are interested in from our "On-line Jobs".

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