Nanny Job Application Form In order to have a greater chance of being hired, please put down as much information as possible. Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you staying at the address listed above? If not, what City, area or cross street?YesNoPhoneWeChat IDEmail Date of Birth (as printed on your ID card)What Nationality are you? Where are you from?Languages SpokenDesired Work Category (Please check all that applies) Sit Month Nanny Part Time Nanny Full Time Live out Nanny Full Time Live In Nanny Part Time Housekeeper Full Time Live In Housekeeper Full Time Live Out Housekeeper Elderly Care / Caretaker Are you able to drive?YesNoDo you have a car that you can use to get to and from work?YesNoIf so, are you willing to be compensated (at a rate of $1 per mile) to use your own car to get to and from work, along with other requests that requires the use of a car?YesNoIf you don't have your own car, are you able to take the bus to get to work?YesNoUnsureAre your vaccinations up to date and are you able to provide proof if requested by the client?YesNoAre you willing to get vaccinated at the clients expense if they request it?YesNoDo you have any forms of Hepatitis?YesNoAre you willing to get blood work done to check for Hepatitis if requested and paid for by the client?YesNoIn regards to your cooking style, what style would best describe yours?Northen style food - dumplings, noodles, stewSouthern style food - rice, stirfry, etcSzechwan / Spicy style foodDo you know how to make soup?YesNoHow long have you been in the United States?Just arrived (less than a week)Under 6 months6 months - 1 yearOver a yearHow many years experience do you have?Less than 11-22-44+Please describe your past working experience in the domestic care industryDo you have a age preference in the type of child that you wish take care of?Infant (0-1 years old)Toddler (1-3 years old)Any AgeHow Many Days a week are you willing to work?Less than 5567Desired Working SituationLive InCommuteIf Commuting, what is the maximum distance you are willing to travel to get to work?less than 10 miles10 - 30 MilesAny (30 + Miles)Desired SalaryPlease list any special skills or abilities that you think would be an asset to the family that you end up working for:Are you able and willing to provide references of your previous employers if asked for by the client?YesNoEmergency Contact Number / Relationship to youToday's DatePhoto*Signature
