Interested Nanny

First Name Last Name

Email Address

Cell Number Alternate Phone Number

Home Information

Home Address

City State Zip

Are you legally authorized to work in the United States?
YesNo

*Proof of citizenship or immigration status verifying legal authorization to work in the United States will be required upon employment.

Have you ever been convicted of a crime? YesNo
If yes, please explain.

Are there any felony charges pending against you? YesNo
If yes, please explain.

Do you smoke or use any tobacco products? YesNo

Getting to Know You

How did you hear about us?

Please tell us why you would like to be a nanny?

Please tell us about your personal values and your thoughts on being a role model for children.

Please tell us about any experience you have working with children and the ages of the children with which you have worked.

Please tell us about any skills you have that might be relevant. Ie. CPR certified, fluent in Spanish, good at cooking, Lifeguard certified.

Approximately how many hours per week would you like to nanny?

When are you available to start?

How long do you think you would be available to nanny?
(i.e. the next 9 months; during summer break; the next 'X' years while finishing college etc.)

Background Information

High School
Name Location (City, State)

Cumulative GPA Did you graduate? YesNo

College/ Post-High Training
Name Location (City, State)

Major area of study Cumulative GPA

Degree/certification Did you graduate? YesNo

If not, when will you graduate?

Graduate School
Name Location (City, State)

Major area of study Cumulative GPA

Degree/certification Did you graduate? YesNo

If not, when will you graduate?

Character References

*You must provide at least 2 character references. These must not include family members.

Reference #1
First Name Last Name

Phone Number

Relationship to applicant: How long have you known this person?

Reference #2
First Name Last Name

Phone Number

Relationship to applicant: How long have you known this person?

Reference #3
First Name Last Name

Phone Number

Relationship to applicant: How long have you known this person?

Most Recent Work Experience

Name of Employer

Address City State Zip

Supervisor’s name Supervisor’s phone number

Can we contact this person as a reference? YesNo

Dates of employment Through Position Held

Additional Work Experience, if applicable

Name of Employer

Address City State Zip

Supervisor’s name Supervisor’s phone number

Can we contact this person as a reference? YesNo

Dates of employment Through Position Held

Additional Work Experience, if applicable

Name of Employer

Address City State Zip

Supervisor’s name Supervisor’s phone number

Can we contact this person as a reference? YesNo

Dates of employment Through Position Held

I certify that all information I provided in this application is true, accurate, correct, and complete. I authorize investigation of all information provided in this application by Northlight Nannies unless I have specifically indicated otherwise. I authorize the references I provided to provide all information concerning my prior employment and any other information they have regarding me and my character. I authorize the disclosure of any information about me to potential clients by Northlight Nannies, including but not limited to the information I and my references have provided. I understand and agree that any misrepresentation, falsification, or material omission of information on this application may be grounds for Northlight Nannies to refuse employment. I also release Northlight Nannies, owners, members, agents, employees, representatives, and affiliates as well as any other persons or entities from any and all liability as a result of providing and/or receiving information regarding me, my employer current or historical, my character, or the use or disclosure of such information. 

Click this box to agree to the above statement.
(Failure to click this box will prevent application from being sent)

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