Babysitter / Nanny Employment Application Form

First Name *

Last Name

Phone *

Email *

Enter your 11 digit national ID number *

Date Of Birth

Emergency Contact Name:

Emergency Phone Number:

Availability

What days are you available to work?

What hours are you available?

Are you available for overnight care?

Are you available for weekends?

Are you available for live-in assignments if needed?

When can you start?

Work Eligibility & Transportation

Do you have reliable transportation?

Are you willing to travel to clients’ homes?

Which areas / locations are you willing to work in?

Childcare Experience

Do you have previous childcare experience?

How many years of childcare experience do you have?

What ages of children have you cared for? (Infants, toddlers, school-aged, teens)

Please list your previous childcare employers (Name, Dates, Duties):

Special Needs Experience (Very Important)

Do you have experience caring for children with special needs?

Please describe your experience caring for a child with autism or special needs:

Are you familiar with any of the following? (Check all that apply)

Are you comfortable working alongside therapists or following therapy plans?

How would you respond if a child with autism becomes overwhelmed or has a meltdown?

Childcare Skills & Responsibilities

Which tasks are you comfortable performing? (Check all that apply)

Safety & Emergency Readiness

Do you have CPR and First Aid training?

Are you willing to obtain CPR and First Aid training if required?

How would you respond in an emergency situation involving a child?

Personal Qualities & Suitability

Why do you want to work as a babysitter/nanny with Serve With Grace Nursing Services?

What qualities make you a good caregiver for children?

How do you build trust with a child?

Reliability & Integrity

Have you ever been dismissed from a job? Yes / No. If yes, please explain:

Are you willing to undergo a background check?

Reference #1

Reference Name

Reference Phone Number

Relationship To Reference

Reference Employer / Company:

Reference #2

Reference Name

Reference Phone Number

Relationship To Reference

Reference Employer / Company:

I certify that the information provided is true and accurate.

Signature

Date

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