Nanny Intake Form Closest Metro Area? * Chicago Austin Houston Nashville Miami/Tampa Charlotte Washington, DC NY/NJ/CT Name * First Name Last Name Email * Phone * (###) ### #### What is your highest level of education? * Are you CPR/First Aid certified? * Yes No Need to renew If yes, date of last certification? If no, when do you plan to renew? How many years of professional childcare/nanny experience do you have? * Post 18yrs of age. This does not include babysitting or occasional positions, only part or full time steady positions. Do you agree to a comprehensive background check? * Yes No Please list three references of previous employers. Include email if possible and phone numbers. * Have you previously worked with a placement agency? * Yes No What is your available start date? * MM DD YYYY Are you open to relocating? * Yes No Possibly What position are you interested in? Thank you!
