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eNannySource.com Nanny Employment Application Name: Referred By: Date: City: State: Zip: Telephone: Cell: Email: Do you own a car Type of car year: What is your desired weekly salary: Job Preferences Live-In Full-Time: Permanent: Mon-Fri: Any Day Weekends: Live-Out Part-Time: Temporary: Tue-Sat: What hours can you work: If you are a live-in do you require a car be provided Use own If you are live-in do you require that you be able to stay on the weekends Y N How many years of childcare experience do you have : Are you Flexible on Days Hours Very Flexible Somewhat Flexible Not Flexible How long do you want to work in this position 6 months 1 year 2 years 3 or more years Type of Job Applying For Nanny Nanny/Houskeeper Nanny/Lite Housekeeping Housekeeper Chef Couple Personal Assistant Companion Estate Manager Please check where applicable what tasks you will do Lt. Housekeeping Carpooling Newborn Heavy Travel Do you: Smoke Yes No Laundry Ironing Toddler Light Travel Drink Yes No Cooking Pet Care School Age No Travel Swim Yes No Errands Marketing No Preference No preference Know CPR Cert: What is your favorite age group Why Maximum number of children you will care for: Would you care for twins Will you work with children that have disabilities What kinds Please check the family situations you would like to work in At home mom At home dad Single mom Single dad Two working parents Is working in a house with pets OK Are you allergic to dogs Y N Cats Y N Languages Spoken: