Nanny Application Form

Personal Information

First Name

Last Name

Date of Birth

Home Phone

Cell Phone

Address

City

State

Zip Code

Email Address

Marital Status

Single Married Divorced Widowed Separated Partner

Do you have your own children?

Yes No

If yes, do they live with you?

Yes No

If yes, who will watch them while you are working?

Can you legally work in the United States?

Yes No

Do you have a passport?

Yes No

Are you CPR certified?

Yes No

If yes, expiration date

Do you have a tuberculosis clearance?

Yes No

If yes, expiration date

Do you have any special medical needs that we should be aware of (allergies, current pregnancy, etc)?

Are you willing to drive while providing nanny services?

Yes No

Tell us about your driving record (check all that apply):

Accidents
DWI/DUI

Suspended License
Speeding Tickets or other Moving Violations

If you answered yes to any of the above, please describe

Prospective Nanny Information

Are you currently employed?

Yes No

When are you available to start a nanny position?

Are you looking for(check all that apply):

  Full Time
  Part Time
  On Call

Live-In
Live-Out

What types of work are you looking for (check all that apply):

Nanny
Housekeeping

Baby Nurse
Household Manager

For part and full-time nanny service (non on-call work) are you willing to make a one year commitment?

Yes No

Where on the island are you willing to work (check all that apply):

West Side
North Shore

East Side (Windward)
Shouth Shore (including Waikiki)

What days/times are you available to work?

Sunday

Start time:

End time:

Monday

Start time:

End time:

Tuesday

Start time:

End time:

Wednesday

Start time:

End time:

Thursday

Start time:

End time:

Friday

Start time:

End time:

Saturday

Start time:

End time:

Desired Salary:

Hourly

Weekly

Monthly

Do you special needs child experience?

Yes No

If yes, please explain:

What age children are you comfortable working with (check all that apply):

  Infants (under 1)
  Toddlers (under 2)
  Preschool (3-5)

Elementary School (6-12)
Teenagers (13+)

Do you prefer working with (check all that apply):

One child only
Two children

Three children
Four children

Are you comfortable working with (check all that apply):

Multiples (twins and triplets)

Special Needs

Education

College or University Name

College or University City and State

College or University Attendance Dates

College or University Degree

High School Name

High School City and State

High School Attendance Dates

Do you have any other certifications, training, or volunteer work that you'd like to share?

Child Care Employment History Note: these references will be verified

Employer Name (A)

Address

City

State

Zip Code

Phone Number

Dates Employed

Number of children

Ages of children

Reason for Leaving

Please describe your duties in this position

Employer Name (B)

Address

City

State

Zip Code

Phone Number

Dates Employed

Number of children

Ages of children

Reason for Leaving

Please describe your duties in this position

Employer Name (C)

Address

City

State

Zip Code

Phone Number

Dates Employed

Number of children

Ages of children

Reason for Leaving

Please describe your duties in this position

Employer Name (D)

Address

City

State

Zip Code

Phone Number

Dates Employed

Number of children

Ages of children

Reason for Leaving

Please describe your duties in this position

Personal References Note: these references will be verified

Reference Name (A)

Address

City

State

Zip Code

Phone Number

Relationship

Reference Name (B)

Address

City

State

Zip Code

Phone Number

Relationship

Reference Name (C)

Address

City

State

Zip Code

Phone Number

Relationship

Reference Name (D)

Address

City

State

Zip Code

Phone Number

Relationship

Essay Questions

Please tell us a little bit about yourself (personal, professional, talents, hobbies, etc.)

Please tell us about your child care experience.

What are your favorite things to do with the children? What are some fun activities that the children could look forward to under your care?

Please describe a typical nanny day. What should the children and parents expect?

Every child is different and some present certain challenges. How would you handle a child that is refusing to listen? What are your thoughts on discipline?

While the weather is usually beautiful in Hawaii, we have our share of rainy days. How would you keep the children entertained on a rainy day?

Please describe your ideal nanny situation. What would the family be like? What would the children be like? What role would you play in their lives?

Is there anything else that you would like Nannies Hawaii™ to know?

Legal

Please read the following agreement carefully before submitting this form.

This application serves as a legal agreement between Nannies Hawaii™ and Applicant (insert your name here), (hereinafter referred to as Applicant) entered into on this date (insert date here.)

Independent Contractor Status:

Nannies Hawaii™ is NOT an employment agency. Applicants will be working as an independent contractor. Since Nannies Hawaii™ is not applicant's employer, it is applicant's responsibility to report state, federal, general excise tax (required in Hawaii), as well as any other taxation required by law.

Indemnification:

Applicant agrees to release, defend, indemnify and hold Nannies Hawaii™ and employees (hereinafter collectively referred to as "Nannies Hawaii™") harmless from any and all losses, expenses, claims, costs, legal judgements, and other fees (including attorney fees) that may arise from or relate to the services provided by Nannies Hawaii™ to client and to applicant. If applicant is found negligent or accused of misconduct, applicant will not hold Nannies Hawaii™ responsible.

Covenant Not To Compete:

Applicant agrees not to work for any client referred by Nannies Hawaii™ for a period of one year after the effective date of applicant's termination (voluntary or unvoluntary) with Nannies Hawaii™. Legal action may be taken against applicants that violate this agreement.

Nannies Hawaii™ Role:

Nannies Hawaii™ will make every effort to find a suitable placement between applicant and potential family. Nannies Hawaii™ cannot guarantee that a placement will be made. The decision to hire the applicant is purely the clients. Nannies Hawaii™ has no part in the final hiring decision. Once an agreement is made between applicant and client, employment terms are strictly between them. Nannies Hawaii™ has no part in the final employment terms. Applicants may select or reject any placement arranged by Nannies Hawaii™.

Agreement:

Applicant acknowledges receipt of a copy of this agreement. Applicant acknowledges that they have fully read and understand each statement in this agreement. Applicant acknowledges all statements above by signing this agreement.

Applicant's Name:
Date:

Submit