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Contact Andrea McDaniel
972-713-7773
Serving the Dallas/Ft.Worth Metroplex since 1997
   
 
Member of the Better Business Bureau
 

 

Pre-employment Questionnaire

Last Name: First Name:
Preferred Name:  
Address:
City: State: Zip:
Home Phone: Cell Phone:
Email: Wk# if we may call you there:
Are you a U.S. citizen?
 If NOT, are you eligible to work in US?
Do you have a or
Green card # or work permit #
Position Desired:
Please check all that apply.
Hours available:
If looking for a permanent job, can you commit to a year?
What are your salary requirements?
What areas are closest to you?
How were you referred to our agency?
All of our placed nannies must have current CPR certification. We will give you ample time to get certified.
Are you CPR certified? If so, when:
(optional)
Height:  Weight:  Birthdate:
Have you ever been arrested, or convicted of a misdemeanor or a felony? If yes, please explain. (This will not necessarily exclude you from getting a job.)
Please describe any present or past health issues.
Do you have allergies?  If yes, please explain:
How many days did you miss last year due to illness? Please describe.
Do you smoke?
Do you swim?
Do you have a valid driverís license?
Do you have a car?  If Yes, Make, Model, Year
License Plate Number
Are you:
Where does your husband work?
Do you have any children?  Ages
Who is your backup if they get sick, etc?
What is your religion? (optional)
Do you have any medical training, please explain?
What are your hobbies?
 
Education
 
  Name & Location # of Years Did you Graduate? Major
High School
 
College
Currently Attending?
Schedule
Honors
Are you fluent in any other languages?  If yes, what languages?
Describe any additional information regarding your skills that might be helpful to a potential employer.
Why do you think you should be considered for this position?
How do you deal with un-cooperative or disobedient children?
 
Work Experience
 
May we call your current employer?
EMPLOYMENT: List most recent jobs first.

Current or Last Employer:
Address: City: State: Zip:
Home Number: Work Number:
Ages of Children When Job Began:
Starting Date:   Ending Date:  Salary:
 Hours worked/Days:
Job Description:
Reason for Leaving:

Employer:
Address: City: State: Zip:
Home Number: Work Number:
Ages of Children When Job Began:
Starting Date:   Ending Date:  Salary:
 Hours worked/Days:
Job Description:
Reason for Leaving:

Employer:
Address: City: State: Zip:
Home Number: Work Number:
Ages of Children When Job Began:
Starting Date:   Ending Date:  Salary:
 Hours worked/Days:
Job Description:
Reason for Leaving:

Employer:
Address: City: State: Zip:
Home Number: Work Number:
Ages of Children When Job Began:
Starting Date:   Ending Date:  Salary:
 Hours worked/Days:
Job Description:
Reason for Leaving:

Names, phone numbers, dates, etc. of any additional CHILDCARE references.
Give name and phone numbers of PERSONAL references not related to you.
Name: Number:
Name: Number:
Name: Number:
Do you have any experience working with a special needs child?
If yes, please explain:
Cared for a nursing baby?
Toilet trained?
Taught a child to swim?
Ages of children that you have worked with in the past:
Do you like to cook?
Willing to prepare meals for the family?
What are your long-term goals/dreams?
Describe your family background. (parents,siblings,birthplace, etc.)
Emergency Contact:
Address:
Phone Numbers:
Relationship:
 
The Nanny Agency, Inc., Nanny Service, Plano, TX
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