First name

Last name

Email

Phone

Address (including city, state, zip)

Birthday

Month

Day

Year

Age:

Available start date or amount of notice needed

Years of Professional Childcare Experience:

How long are you hoping to maintain a position?

How many minutes are you willing to commute?

Hourly salary expectations:

Payroll preference

On payroll

Off payroll

Mixture/Partial payroll

No preference

Please list all degrees and certifications:

Are you legal to work in the U.S.?

English Level

Other languages and proficiency level:

Do you have a valid driver's license?

Yes

No

Driver's license number

Driver's license issuing state

If the family does not provide a work vehicle, are you comfortable using your own with mileage reimbursement?

Yes

No

If yes; Year, make, model of vehicle

Are there any citations or tickets on your driving record to be aware of? If yes, please describe:

Have you ever been convicted of a crime? If yes, please describe:

Do you have any children?

Yes

No

If yes, ages of your children:

Are you a smoker?

Are you comfortable working with pets in the home?

Do you have any pet allergies, severe allergies, or medical conditions?

Please list all vaccinations you are up to date on and could provide proof of (including TDAP, MMR, Covid, Yearly Flu, etc.)

Please list one emergency contact: (Name, relationship, phone)

Please list three professional, childcare-related, most recent and/or most relevant former employer references:

(we will always notify you at least 24 hours in advance of contacting)

Reference 1:

Name

Phone

Relationship

Is this job on your resume?

Yes

No

Reference 2:

Name

Phone

Relationship

Is this job on your resume?

Yes

No

Reference 3:

Name

Phone

Relationship

Is this job on your resume?

Yes

No

Candidate Profile Photo:

Profile photo must be family-friendly and appropriate to use on a job application. Please avoid photos with sunglasses, revealing clothing, filters, non-smiling photos, etc.

Nanny Profile Photo

Please upload any additional documents or photos for your candidate profile:

I.e. Cover letter, photo of First Aid/CPR certification, any other related certifications, letters of recommendation, etc. You may also text or email these items directly to your Placement Coordinator if that's easier!

File upload

By checking here, I agree that Connecticut Nanny Agency has the sole discretion to decide if an applicant is a good fit for any given family or position, or if we believe a candidate would or would not be a good representation of our agency, for any reason or for no reason at all.

Applicant Signature

Signature field is empty.

Nanny Application Form

Candidate Profile Photo:

Please upload any additional documents or photos for your candidate profile: