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Nanny Registration Form

Please cmplete the following aplication in order to register with our agency. We will not be able to accept your application unless all sections are completed. If a section does not apply, please write N/A (not applicable).

Name:
    
Address:
      
City:
      
State: Zip:    
E-mail:
  
Date of Birth:
Phone:
  
Place of Birth (city, state)
Driver's License #:
    
Height:
State Issued:
    
Weight:
Expires:
    
 
       

Education:

Please list all educational institutions that you have attended, beginning with high school.
Name of Institution Location Dates attended Degree/Certification Attained Major

Experience:

Please list all children positions held (full or part-time nanny, occaisional babysitter, daycare worker, teacher, etc.) listing most recent first.

Employer: Address: Description: Please write a brief description held. Be sure to state how frequently you cared for the childre, i.e. full-time, one day per week, etc. Also, please note any other responsibilities you had involving the household, i.e. cooking, laundry, running errands, etc. Reason for leaving:

Hobbies/Activities/Groups:

Please list all of your hobbies and interests in and outside the home. Also list any professional organizations, recreational clubs, community service groups, etc. that you belong to presently or have belonged to in the past.
Description:

Additional references:

i.e. teacher, family friend, clergyman, co-worker, former employer, additional childcare references, etc. NO family members, please. Must provide at least two (2) references.
Name: Address: Phone: Relationship to you:
Personal Data:  
Date available to start:
If yes, please list:
  
Violation:
Dates & explaination:
  
   
If yes, please list ages:
  
Salary expectations (net per week):
  
Essay Questions:
Describe why you would like to be a nanny:
Describe your relationship with your family (parents & siblings):
Describe your childhood:
Describe your personality:
Describe your experiences with children:
Describe your future plans for yourself:
Describe what you have been doing for the last five years:
Describe a positive experience with a child:
Describe a negative experience with a child, and how you handled it:
What are your strongest and weakest points?
Do you have anything else that you would like the family to know about you?
You may also write a brief paragraph regarding the type of family/position you are looking for.
How did you hear about The Dakota Nanny Company?

You may also mail/fax this infomation to:

Dakota Nanny Company
29 Valley Road
Montclair, NJ 07042
Phone: 1-800-994-8585
Fax: 973-509-5281
E-mail: info@dakotananny.com