Preliminary Registration to Become a Nanny General Information: Nanny Name: Age: Address: City: State:   --select--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbisDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexaxUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip: Home Phone:     Personal Information: Do You Smoke: Yes No How Much: Marital Status: Single Married Divorced Separated Widow Do you have children? Yes No Ages of children: (optional) Currently: Working now? Yes No If yes, where? Are you currently attending school? Yes No If yes, where?   Availability (NOTE: We Place Nation-wide): When Are You Available To Start?: Preferred Locations:   Live-in   Live-out What Childcare Experience have you had:   Do you have a High School diploma or GED? Yes No   If no, please explain? Can you make at least a 1 year commitment? Yes No   If "no" how long can you commit? Are you under doctor's care or taking medication for any reason? Yes No          If yes, what medication and why? Have you ever received counseling? Yes No    If yes, please explain? Do you have any learning disabilities? Yes No      If yes, please explain? Do you have a valid driver's license? Yes No In What State?: --select--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbisDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexaxUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Have you ever been arrested or convicted of any offense? Yes No    If yes, please explain? How would you like to receive application? Fax Email Mail Email Address: Fax Number: How did you hear about Nannies of Nebraska?: Friend Internet Newspaper Other Explain: Any Additional Comments? Home | Contact Us | General Information | Register To Be A Nanny | Register To Hire A Nanny | Nanny FAQ | Family FAQ ©2008 Nannies of Nebraska.