Premier Nanny Network Intake Form- Caregiver
Please complete the following form to take the first step in finding a fulfilling, amazing career!
Email *
Name *
Email *
Address *
Date of Birth: xx/xx/xxxx *
Are you authorized to work in the USA? *
Do you have a valid driver's license? *
What type of position are you seeking? 
(check all that apply)
 *
Required
What is your *desired* hourly/ salary?  *
Are you available to work evenings and weekends? *
Are you available to work Holidays or Special Events? *
Are you open to traveling with families? *
Are you open to cleaning household with negotiated cleaning rate and schedule? *
Do you have any schedule restrictions? *
Are you available to work when the children are sick? *
What is your desired schedule? Please list days and times. *
How many years of professional childcare experience do you have after the age of 18?
(Watching your own children/ family does not qualify) 
 *
Please check ages of children you have experience with (check all that apply):  *
Required
How many years of Elder Care Experience do you have? *
Please describe your previous nanny/ management/ elder care experiences (provide details on past roles, families, duties, and duration of employment) *
Do you have CPR/ First aid certification? *
Do you have any childcare-related certifications? *
If yes to childcare-related certifications, please list below: (if no, please put N/A) *
Do you have any experience with the following? 
Check all that apply
 *
Required
Highest Level of Education Completed *
Relevant Courses or Degrees *
Additional Child or Elder Care Training or Continuing Education  *
Have you ever been convicted of a crime? *
Do you consent to multiple, thorough, background checks? *
Do you consent to Driving Record's Check? *
Professional Reference 1
Please include: Name, Relationship, Phone Number, Email, Duration of employment 
 *
Professional Reference 2
Please include: Name, Relationship, Phone Number, Email, Duration of employment
 *
Professional Reference 3
Please include: Name, Relationship, Phone Number, Email, Duration of employment
 *
What do you value most in your role as a nanny or caregiver? *
How do you approach discipline or boundaries with children or elderly in your care? *
How do you handle stressful situations or emergencies? *
Have you worked with other agencies? *
If yes to working with other agencies, please provide details (name, state, etc.) {If no, please put N/A} *
Why do you want to work with Premier Nanny Network? *
Do you have any allergies or health conditions that may affect your ability to perform your job duties? *
If yes to allergies or health conditions, please detail how they may impact your ability to provide care in your role. If no, please put N/A. *
Are there any specific preferences you have when working with families? (pet-free home, dietary preferences, do not want to drive, etc.) *
Is there anything else you would like us to know about you? *
Please share your 5 year goals (where do you hope to be, what do you want to be doing, and how are you working toward these goals today). *
Please share with us any details that we should know about you to ensure we match you with a family and positions you will love. *
Have you submitted your resume to premiernannynetwork@gmail.com? 
If not, this is a requirement to proceed to the next step.
 *
I understand that providing any false information will result in the termination of my candidacy.  *
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