Aloha Nannies Nanny Application

Nanny Application

Please complete the following form and click Submit. You will receive an email copy of this application. Please save this email and reference it if you need to make any changes in the future. Note: you can not save this form and continue it later, it must be completed and submitted at the same time. Allow yourself 15-30 minutes to complete.

A * next to each field label means that an entry in this field is required.
* First Name
* Last Name
* Address
* City
* State
* Zip
Country
Home Phone (include area code)
Work Phone (include area code)
Cel Phone (include area code)
Fax (include area code)
* E-mail Address
Date of Birth

Childcare Employment History
Most Recent		Please indicate areas of expertise
Employer: Address: City: State: Zipcode: Phone Number: Childrens ages: Date Started: Date Left:		Transportation Bathing Reading Clothing	Bottle Preparation Diapers Feeding Tutoring
Other job duties (be specific):

Second Most Recent		Please indicate areas of expertise
Employer: Address: City: State: Zipcode: Phone Number: Childrens ages: Date Started: Date Left:		Transportation Bathing Reading Clothing	Bottle Preparation Diapers Feeding Tutoring
Other job duties (be specific):

3rd Most Recent		Please indicate areas of expertise
Employer: Address: City: State: Zipcode: Phone Number: Childrens ages: Date Started: Date Left:		Transportation Bathing Reading Clothing	Bottle Preparation Diapers Feeding Tutoring
Other job duties (be specific):

Please Provide two Character references, i.e., work, school, religious, etc.:
Name: Phone: Relationship:		Name: Phone: Relationship:

Please provide Professional references relevant to assignments interested in:
Name: Phone: Relationship:		Name: Phone: Relationship:

Describe experience with special needs children:

Have you ever been convicted of a crime or violation of the law? Yes No		If yes, please explain:
Describe your experience with the elderly:
Are you allergic to animals? Yes No		If Yes, please explain:
Do you Swim? Yes No
In Case of Emergency Notify: Name: Phone: Relationship: Street Address: City: State: Zip: Telephone Number(s):

Educational Background: 1. High School: Name of School & Location: Dates Attended: Graduation Date: Degree or Diploma: 2. College or University: Name of School & Location: Dates Attended: Graduation Date: Degree:

List any additional course work, seminars, training or volunteer work:

Are you legal to work in the U.S.? Yes No
CPR certified? Expiration Date Yes No
TB test? Expiration Date Yes No
Passport? Expiration Date Yes No

PERSONAL INFORMATION
Marital Status: Married Widowed Divorced Separated Single Partner
If you have children, list names, ages and whether they live with you 1. Name: Age: Live with you: 2. Name: Age: Live with you: 3. Name: Age: Live with you: 4. Name: Age: Live with you:
Who cares for your children while you are working?		Caregivers name, address and telephone number
Are you working now?Yes No		When can you start a new job?
During the next year, will any of the following activities conflict with your availability to work? (Check all that apply) Scheduled vacations/holidays Religious holidays/obligations Scheduled medical procedures Getting married Giving Birth School or evening classes Other No activities planned If "Other", please explain
What duties are you willing to perform in addition to child care? (check all that apply)		What ages and types of children are you comfortable working with? (check all that apply)
Cook for children Driving/Errands Dust/Vacuum Travel Laundry for family Beds for family Pet care Tutoring/Homework Floors Occasional Overnights	Laundry for children Beds for children Indoor Plants Cook for family Driving with children Bathrooms Additional babysitting Shopping Ironing	Newborn to 1 year 3-5 years 13 years or older Triplets 1 child only 3 or more children	1-2 years 6-13 years Twins Special Needs 2 children
How did you find out about Aloha Nannies Agency?		Have you registered with Aloha Nannies before: Yes No
Describe your driving record: 1. Speeding tickets (y/n): 2. Accidents/your fault (y/n): 3. Driving under the influence (y/n): 4. Other moving violations (y/n): 5. Accidents/not your fault (y/n): 6. Driver License suspended (y/n): If you ansered yes to any of the above, please explain:
Current Drivers License No.	State of Issuance	Expiration Date:
Have you ever been issued a drivers license from another state or country? Yes No		If yes, please explain:
What type of work are you looking for? (check all that apply)		What days and hours are you available to work?
Nanny Nanny/Light Housekeeping Nanny/Full Housekeeping Housekeeping only Baby Nurse Household Manager Long Term (1 year+)	Live in or out Live In Live Out Part Time Full Time On-call Babysitting Weekend Temporary	Monday: From: To: Tuesday: From: To: Wednesday: From: To: Thursday: From: To: Friday: From: To: Saturday: From: To: Sunday: From: To:
Salary range desired (complete all that apply):
Hourly: Minimum Maximum Weekly: Minimum Maximum Overnight: Minimum Maximum

Most employers require a 1 year commitment on the part of the nanny. Are you willing to commit to this?: Yes No

Please write a little about yourself, your interests and your talents:
Please tell about your theories on raising children:
What role will you, as nanny, play in the lives of the children you are caring for?
Please describe the perfect family to work for. What would the parents and children be like?
Please describe your theories on discipline for children:
Please list your favorite activities for children. What would you do on a rainy day?
Please check one box: You may contact my present employer You may NOT contact my present employer.

Please read the following carefully before submitting:
You understand that Aloha Nannies is not an employment agency and applicant will be working as an independent contractor. In the event of misconduct or negligence by you, you will not hold Aloha Nannies responsible. Nanny understands that Aloha Nannies will make agreed upon efforts to make a referral, which will result in the nanny being offered a position with a family. Aloha Nannies makes no guarantees or promises that the nanny will be offered a position. Nanny understands that the decision to hire the nanny rest solely on the client. Once a decision to accept employment rests solely with the client and the nanny. You understand you have the right to choose or reject any work opportunity offered to you by Aloha Nannies. INDEMNIFICATION: Nanny agrees to release, defend, indemnify and hold harmless Aloha Nannies & teachers and its directors, officers and employees (hereinafter collectively referred to as "Aloha Nannies") from any and all claims, losses, expenses, fees (including attorney’s fees) costs and judgements that may arise from or relate to the services provided by Aloha Nannies to client and nanny. Aloha Nannies is referral service acting on your behalf and is not your employer; therefore, the responsibility of reporting general excise, federal and state taxes and any other required taxation is yours. You agree not to work for any client referred to you by Aloha Nannies for one year after the effective date of your disassociation with Aloha Nannies. It is understood that no interviews will be scheduled until this contract has been signed and received by Aloha Nannies. I hereby acknowledge receipt of a copy of this agreement. You agree that you have fully read and understood each statement in this agreement and acknowledge this by your signature below. Signature Date
Please type your full name:		Date:

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Nanny Application

Childcare Employment History

PERSONAL INFORMATION