(303) 717-1841


Night Owl Nanny Care


Employment Application
Are you a U.S. Citizen? *
Can you prove you have a legal right to work in the U.S.? *

Background Information

Do you have a Colorado driver's license?
Have you ever held a valid driver's license in another state?
Have you ever been convicted of a crime?
Do you own a car?

Position Desired

Please select yes to appropriate options

On Call/Occasional Sitter
Summers Only


Length of commitment?
Will you be attending school in the next year?
Do you have any situation in your life that could change your availability?
How far are you willing to travel?

Compensation Requirements

(Note: Salary levels depend on experience on education

Are you willing to negotiate?


Working with two families to fill desired hours?
Nanny­share situation (working with two families at the same time)?
Working while a parent is at home as a Mom’s helper?
Working while a parent is at home in the home office working?

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

Toddlers (1 - 3)
Preschool (3 - 5)
Elementary (6 - 9)
Middle School (10 - 14)



Are you CPR Certified?
Are you First Aid Certified?
Are you bilingual?
Do you have any experience working with a special needs child?
Are you certified to administer drugs to a child?
Do you have special training such as teaching or substitute teaching?
Do you have experience as a tutor or mentor?
Do you have experience with twins? Triplets?

Childcare Employment

Please tell us about your childcare experiences

Childcare References

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

Reference #1

Reference #2

Reference #3

Other Employment

(Last two positions other than childcare)

Personal References

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

Reference #1

Reference #2

Health Information

Do you smoke?
Do you have any physical disability which would prevent you from performing specific kinds of work?
Are you now, or have you been treated for a drug or alcohol habit?
Do you have or have you ever been told that you have allergies (i.e., to pets)?
Have you had TDAP injection within last 10 years? Please provide documentation.
Did you have a flu shot this year? Please provide documentation

Nanny Job Description

Duties may include:
  • Provide onsite childcare at families home
  • children to/from activities
  • infant(s)/child(ren)
  • Bathe 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.

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

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