White House Nannies Inc. Initial Employment Application Form


White House NanniesSPECIAL NOTE: Please complete the application in its entirety.   We are trying to anticipate what your potential employers will want to know.   If you choose not to answer some questions, it is acceptable to write "no answer."   However, the application and all other documents provided are proprietary to White House Nannies, Inc. and are registered and copyrighted.   If you decide not to apply we will hold your application as incomplete or destroy it, as you wish.


Date Completed:

Position Type (required field)
Long-term Placement Live-Out
Long-term Placement Live-In
Nanny/ Household Manager Live-Out
Nanny/ Household Manager Live-In
Temporary Service
Summer Nanny (May-August)
Newborn Specialist

Personal Information (required fields)
Name
Address
City
Home Phone
Work Phone
Cell/Pager
E-Mail address
Maiden Name
Other Names Used
How long have you been at this address?
Email
Nearest Friend or Relative
Phone
What is the highest level you completed in school?
What schools/colleges did you attend?
Grade School:
High School:
College:
Major:

Have you ever applied to White House Nannies, Inc.? Yes No
If so, under what name and what year?

Personal History (required fields)
Why are you interested in childcare work?

How would you describe your personality?

Rate yourself on these qualities
FAIR
AVERAGE
EXCELLENT
Flexibility
Sense of Humor
Good Nature
Common Sense
Neatness

What age and how many children do you prefer to care for?
What form of discipline do you believe is most effective?

 

Please check all that apply to your past experiences:
Attention Deficit Disorder
Behavioral Disorders
Learning Disabilities
Physically Handicaps
Mental Handicap
Infant on a Monitor
Twins/Multiple Births
Mildly Ill Child
Care w/ Parent at Home
Toilet training
24-hour Live-in Care
New Mother/Baby Care

Please indicate YES if currently certified:
Infant/Child CPR
Yes No
Adult CPR
Yes No
First Aid
Yes No
Nurse's Aid
Yes No
Nurse (RN/LPN)
 Yes No
Teaching Certificate
Yes No

Can you cook?
Yes No
Can you sew?
Yes No
Can you swim?
Yes No

Would you be willing to do household tasks such as cleaning, dusting, bed making, dishes, laundry or errands?
Yes No
Explain:

Do you smoke?
Yes No
Do you drink?
Yes No
Would you care for pets?
Do you like dogs?
Yes No
Do you like cats?
Yes No Yes No

Do you have any religious requirements?

Would you live and/or work with a family of another faith?

Are you able to make a MINIMUM one (1) year commitment for Permanent placement? Yes No
Are you able to make a MINIMUM six (6) month commitment for Temporary placement? Yes No

When would you begin work?

What are your long-term job or career goals?

What are some of your hobbies or interests?


Tell us about any travel experiences you have had:


Do you have any musical or athletic talents?

What languages do you speak?

Transportation for permanent positions vary; if you do not own your own car, could you pay your own plane, train or bus fare and be reimbursed by the employer?

How did you learn about White House Nannies, Inc.?

Legal History (required)
Are you legal to work in the United States? Yes No
If YES, you must provide documentation regarding your work status (Work Permit, Green Card, Passport, other). Failure to do so will result in your disqualification (candidacy being terminated).

Have you ever been arrested or called in for questioning by the police? Yes No
If yes, what was the charge or reason?

Have you ever been convicted of a crime? Yes No
If yes, what was the offense?

Please explain:

Do you drive?
 Yes No

Driver's License Number:
List any restrictions on your license:

Do you own a car?
 Yes No
Auto insurance company:
How many accidents have you had in the last five (5) years?
How many traffic tickets have you had in the last five (5) years?

Long-Term Placement Preferences (required)
Please check any positions you are interested in only if you are interested in a long-term placement:
  Permanent Division
Live-In Childcare
Live-Out Childcare
Nanny/Household Manager: Live-In
Nanny/Household Manager: Live-Out
Part-time Childcare
Childcare and Housekeeping

Temporary Division Placement Preferences (required)
Temporary Division Types of Care
 
Temporary Division Caregiver Availability
Please check type of care you can provide:
Please check days and times you can work:
Childcare Daytime
Extended care (temporary Overnight) Evenings
Newborn Specialist Weekends
Summer (May-August) Overnights

Personal Reference
Please furnish the full name, work and home telephone numbers of a person(s) who can give you a personal reference. This can be a family friend, teacher, minister or anyone who is not related to you, but knows you well.
Name:
Work Phone:
Home Phone:
How does this person know you?

Employment References
LIST ALL EMPLOYMENT HISTORY PERTAINING TO CHILDCARE FOR THE LAST 10 YEARS. START WITH YOUR CURRENT OR LAST JOB. (Please include any business references so that we can establish a work chronology).

Employer Name:
Address:
Telephone:
 Date employed from to
Position Held:
Starting Salary: $ Ending: $

If childcare, ages of children:

Responsibilities:

Reason for leaving:
May we contact this employer?
 Yes No
If NO, please explain:


Reference 2
Employer Name:
Address:
Telephone:
 Date employed from to
Position Held:
Starting Salary: $ Ending: $

If childcare, ages of children:

Responsibilities:

Reason for leaving:
May we contact this employer?
 Yes No
If NO, please explain:


Reference 3
Employer Name:
Address:
Telephone:
 Date employed from to
Position Held:
Starting Salary: $ Ending: $

If childcare, ages of children:

Responsibilities:

Reason for leaving:
May we contact this employer?
 Yes No
If NO, please explain:


Reference 4
Employer Name:
Address:
Telephone:
 Date employed from to
Position Held:
Starting Salary: $ Ending: $

If childcare, ages of children:

Responsibilities:

Reason for leaving:
May we contact this employer?
 Yes No
If NO, please explain:


Reference 5
Employer Name:
Address:
Telephone:
 Date employed from to
Position Held:
Starting Salary: $ Ending: $

If childcare, ages of children:

Responsibilities:

Reason for leaving:
May we contact this employer?
 Yes No
If NO, please explain:


I CERTIFY THAT THE ANSWERS GIVEN HEREIN AND THE INFORMATION PROVIDED ARE FACTUAL, TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT FALSIFICATIONS, OMISSIONS OR MISREPRESENTATIONS MAY BE CAUSE FOR REJECTION OF MY APPLICATION TO WHITE HOUSE NANNIES, INC. OR ANY OF ITS CLIENTS, AND IF EMPLOYED BY A CLIENT OF WHITE HOUSE NANNIES, INC. MAY BE CAUSE FOR IMMEDIATE DISMISSAL IF DISCOVERED AFTER MY EMPLOYMENT. I AUTHORIZE INVESTIGATION OF ALL INFORMATION CONTAINED IN THIS APPLICATION AND ANY SUPPLEMENTAL MATERIAL SUPPLIED BY ME AS MAY BE NECESSARY. I FURTHER AUTHORIZE ANY EMPLOYER, PERSON, CORPORATION, OR EDUCATIONAL INSTITUTION LISTED HEREIN, INCLUDING WHITE HOUSE NANNIES, INC., TO ANSWER ANY AND ALL QUESTIONS AND AGREE TO HOLD ALL PERSONS HARMLESS FOR PROVIDING ANY AND ALL INFORMATION WITHIN THEIR KNOWLEDGE OR RECORDS.

Electronic Signature: By selecting submit, you hereby verify that the above information is accurate. If not, please select cancel.