Nanny Application

Step 1 of 5

General Information Name *
Email *
Photo of yourself* max 2.5mb
Address
City
State
Zip
Home Phone
Cell Phone
What are you looking for in a family?

General Information cont. Are you a 18 years or older? Yes No
No. of Years in Los Angeles
No. of years in the US
Are you a US citizen? Yes No

When did you immigrate?
What is your work authorization? Green Card Work Permit Other
What country are you from?

Miscellaneous Are you CPR certified? Yes No
Are you registered with Trustline? Yes No

Step 2 of 5

Driving Information Can you travel with the family as needed? Yes No
Do you drive? Yes No

How long have you been driving?

Do you have a car? Yes No

List make, model, and year

Do you have insurance? Yes No

List insurance company

Can you use your car for work? Yes No
Can you drive stick shift? Yes No
Describe your driving record (check all that apply) Speeding Tickets Accidents/Your Fault Driving under the Influence Other moving violations Accidents/Not your fault Driver License suspended

Please explain the above checked items

Current Driver License No.
State of Issue
Have you ever been issued a driver license from another state or country? Yes No

Please explain

Work and Availability What type of work are you looking for? (Check all that apply) Nanny Nanny/light hskp Nanny/full hskp Hskp only Live in Live out Live in or out On-call babysitting Full Time Part Time Weekend Overnights Long term (1 year+) Temporary Traveling
What days and hours are you available to work? Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Mon: From____ To ____

Tue: From____ To _____

Wed: From____ To _____

Thu: From____ To _____

Fri: From____ To _____

Sat: From____ To _____

Sun: From____ To _____

Are you currently working? Yes No
When can you start a new job?

Step 3 of 5

Salary

Enter your desired salary range before tax and after tax (complete all that apply)

Full Time (Weekly Salary)
Hourly
Weekend

Duties & Skills What duties are you willing to perform in addition to childcare? (Check all that apply) Cook for children Laundry for children Driving/errands Beds for children Dust/vacuum Indoor Plants Travel Cook for family Laundry for family Driving/with children Beds for family Bathrooms Outdoor Areas Additional Babysitting Pet Care Shopping/errands Tutoring Ironing Floors Office/Personal Assistance Occasional overnights
Please rate your cooking skills
Please describe your comfort in working with household pets
What age(s)/types of children are you comfortable working with? (Check all that apply) Newborn to 1 year 1-2 years 3-5 years 6-13 years 13 years or older Twins Triplets Special needs 1 child only 2 children 3 or more children

Please explain

4 of 5

Employment History

(list all jobs, childcare and non-childcare, beginning with most recent employment)

How many references would you like to provide? (Please check all boxes if you want to provide 3 references) 0 1 2 3

Reference #1 Employer Name
Address
Your Position
Home Phone
Cell Phone
Work Phone
Days Worked
Hours Worked
Live In/Live Out Live In Live Out
Starting Salary
Ending Salary
Dates Employed
Names and ages of child(ren) when you started
Daily duties in addition to childcare (check all that apply) Cooking Driving Laundry Housekeeping Errands/Shopping Pet care Travel Personal Assistance Other
How did you find this job?
Why did you leave this job?
May we contact the employer? Yes No

Explain

Reference #2 Employer Name
Address
Your Position
Home Phone
Cell Phone
Work Phone
Days Worked
Hours Worked
Live In/Live Out Live In Live Out
Starting Salary
Ending Salary
Dates Employed
Names and ages of child(ren) when you started
Daily duties in addition to childcare (check all that apply) Cooking Driving Laundry Housekeeping Errands/Shopping Pet care Travel Personal Assistance Other
How did you find this job?
Why did you leave this job?
May we contact the employer? Yes No

Explain

Reference #3 Employer Name
Address
Your Position
Home Phone
Cell Phone
Work Phone
Days Worked
Hours Worked
Live In/Live Out Live In Live Out
Starting Salary
Ending Salary
Dates Employed
Names and ages of child(ren) when you started
Daily duties in addition to childcare (check all that apply) Cooking Driving Laundry Housekeeping Errands/Shopping Pet care Travel Personal Assistance Other
How did you find this job?
Why did you leave this job?
May we contact the employer? Yes No

Explain

Step 5 of 5

Health Do you have health insurance? Yes No

Company

Have you been tested for TB? Yes No

Give the Date Of and the Results

Have you had a complete physical examination? Yes No

Give the Date of and Physician

Do you smoke? Yes No

Describe usage

Do you drink? Yes No

Describe usage

Will you agree to a pre-employment physical (paid for by the employer)? Yes No

Personal Information Marital Status
Do you have children? Yes No

Please give each of your children's Name, Age, School/Occupation, and City (if not living with you)

Who cares for your children while you are working?

What are your hobbies and interests?
Which of the following activities do you enjoy and are comfortable doing with children? Swimming Snow skiing Bicycling Rollerblading Soccer Baseball Basketball Golf
What languages do you speak fluently?
Do you have a musical background? Yes No

Explain

Please list your educational background
List any additional course work, seminars, training or volunteer work

Final Questions Why do you want to work with children?
When did you first start working with children?
Which statement best describes you (check all that apply) I want to work with children on a long-term basis. Working with children is my career of choice. I enjoy working with children but haven’t decided for sure on a long-term career choice. I’m interested to work with children on a temporary, fill-in basis only. I’m interested in working with children as an occasional babysitter.
What form of discipline do you feel is most effective?
Under what circumstance, if any, do you feel it is appropriate to spank a child?
How long of a commitment can you make to the next family who hires you?
What are your long-term plans?
Have you ever been fired from a job? If so, why?
Have you ever been accused of or convicted of child abuse? Yes No
How did you find out about Westside Nannies? Craigslist Flyer Newspaper LA Magazine Other Person Referral

Name

Would you like to be an on-call Babysitter for Westside Nannies? Yes No

Add any files you would like (resume, etc.) File 1 max 2.5mb
File 2 max 2.5mb
File 3 max 2.5mb

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Westside Nannies 6206 Orange St, Los Angeles, CA 90048
310.359.5300 | info@westsidenannies.com

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