(303) 717-1841

Careers

Night Owl Nanny Care

EMPLOYMENT APPLICATION


Personal Profile

Date of Application:

Name:

Date of Birth:
Date: Month: Year:

Street Address:

How long at current address?

City or Town:

State:

Zip:

Home Phone:

Cell Phone:

Email Address:

Are you a US Citizen?
YesNo

If not, can you prove you have a legal right to work in the US?
YesNo


Background Information

Alias (all other names used) and/or maiden name?

Do you have a valid Colorado driver’s license?
YesNo

License #:

Have you ever held a valid driver’s license in another state?
Yesno

Year?

State of?

Other states or countries you have lived in?

Number of accidents/moving violations in which you were the driver in the last three years:

Have you ever been convicted of a crime:
YesNo

If so, please explain:

Do you own a car?
YesNo

Make:

Model:

Year:


Position Desired

Please say yes to appropriate options

On Call/Occasional Sitter:
YesNo

Full­time:
YesNo

Part­time:
YesNo

Summers Only:
YesNo


Availability:

Date Available:

Sunday:
until
I am unavailable on this day.

Monday:
until
I am unavailable on this day.

Tuesday:
until
I am unavailable on this day.

Wednesday:
until
I am unavailable on this day.

Thursday:
until
I am unavailable on this day.

Friday:
until
I am unavailable on this day.

Saturday:
until
I am unavailable on this day.

Length of commitment: One­Year commitment?

Other:

Will you be attending school in the next year?
YesNo

Do you have any situation in your life that could change your availability?
YesNo

How far are you willing to travel?

Miles or approximate minutes:

Preferred cities and towns:


Compensation Requirements

(NOTE: Salary levels depend on experience and education)

Acceptable Hourly Rate:

Are you willing to negotiate?
YesNo


Preferences

Working with two families to fill desired hours?
YesNo

Nanny­share situation (working with two families at the same time)?
YesNo

Working while a parent is at home as a Mom’s helper?
YesNo

Working while a parent is at home in the home office working?
YesNo


Please say yes to the ages of children you would like to care for:

Infants:
YesNo

Toddlers (1­-3):
YesNo

Preschool (3­-5):
YesNo

Elementary (6-­9):
YesNo

Middle School (10-­14):
YesNo


Education

High School attended:

Date graduated or attended:

College attended:

Date graduated:

Major:

Other:


Certifications:

Are you CPR Certified?
YesNo

Are you First Aid Certified?
YesNo

Are you bi­lingual?
YesNo

If yes, what languages?

Do you have any experience working with a special needs child?
YesNo

If so, please explain:

Are you certified to administer drugs to a child?
YesNo

Do you have special training such as teaching or substitute teaching?
YesNo

Do you have experience as a tutor or mentor?
YesNo

Do you have experience with twins? Triplets?
YesNo

Do you have children? Ages?


Childcare Employment

Please tell us about your childcare experiences

Family Name:

Address:

Phone:

# of children cared for:

Ages of child(ren) when employment started:

Dates employed by this family:


Family Name:

Address:

Phone:

# of children cared for:

Ages of child(ren) when employment started:

Dates employed by this family:


Family Name:

Address:

Phone:

# of children cared for:

Ages of child(ren) when employment
started:

Dates employed by this family:


Childcare References

NOTE: You must have three (3) childcare references, other than family and more than as an occasional sitter

Reference #1

Name:

Address:

Dates employed:

Phone:


Reference #2

Name:

Address:

Dates employed:

Phone:


Reference #3

Name:

Address:

Dates employed:

Phone:


Other Employment

(Last two positions other than childcare)

Dates From/To:

Employer:

Address:

Position held:

Supervisor:

Phone #:


Dates From/To:

Employer:

Address:

Position held:

Supervisor:

Phone #:


Personal References

(List two (2) personal references other than family)

Name:

Dates Known:

Relationship to You:

Contact phone numbers:

Name:

Dates Known:

Relationship to You:

Contact phone numbers:


Health Information

How is your general health:

Do you smoke?
YesNo

Do you have any physical disability which would prevent you from performing specific kinds of work:
YesNo

If yes, please explain the work limitations:

Are you now, or have you been treated for a drug or alcohol habit:
YesNo

If yes, please explain:

Do you have or have you ever been told that you have allergies (i.e., to pets):
YesNo

If yes, please explain:

Have you had TDAP injection within last 10 years? Please provide documentation.
YesNo

Did you have a flu shot this year? Please provide documentation
YesNo

Primary Care Physician’s name?

Contact number?

Office Address?

I certify that the information I have furnished herein is true and accurate.

Signature of Applicant

Date


Nanny Job Description

Duties may include:

  • Provide onsite childcare at families home
  • Drive children to/from activities
  • Feed infant(s)/child(ren)
  • Bath infant(s)/child(ren)
  • Laundry for infant(s)/child(ren)
  • Change diaper pail
  • Provide light housework if necessary
  • Help with homework if applicable
  • Occasional errands for family

We recognize that each job description is different and may include other responsibilities. By signing this form, you authorize that you are applying for a job similar to the duties above and are willing to be presented to appropriate families at the discretion of Night Owl Nanny Care. Once presented/interviewed with families, it is your sole decision to accept employment or decline. If you accept, you accept that you are a contracted employee of Night Owl Nanny Care.

Date:

Please take a moment to read and sign our contract. You can either send it to us via email or fax. Click here to download.

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