Preliminary Registration to Become a Nanny

General Information:

Nanny Name:

Age:

Address:

City:

State:  

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?:

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?:

Explain:

Any Additional Comments?


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Read this article on Professional Nannies which was published on NETNebraska.org and includes comments from Candi Wingate, President of Nannies Of Nebraska.


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