Apply | Maui Nannies

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Cell Phone

Email*

Social Security #*

Date of Birth*

Do you have a valid driver's license?*

Yes
No

State / Province

Have you ever been convicted of a crime?*

Yes
No

If yes, explain

Do you smoke?*

Yes
No

Do you take drugs?*

Yes
No

Do you have any medical conditions?*

Yes
No

If so, explain

What is your energy level?*

Low
Medium
High

Are you physically able to work as a nanny?*

Yes
No

What is your previous nanny experience?

Live-in nanny
Live-out nanny
Mother's helper

Other experience

Describe an experience as a nanny/ mother’s helper/babysitter

What did you like/dislike about the nanny/ mother’s helper/babysitter position?

What would you have done differently?

What is your previous experience working with children?

Teacher
Teacher's aide
Camp counselor
Babysitter
Raised your own children

Other previous experience

What skills have you employed as a nanny

Cared for nursing baby
Gave solid foods to baby
Provided 24 hour childcare
Helped toilet train a toddler
Taught child to swim
Prepared formula
Gave medications

Cared for sick children, explain:

Other skills

Have you worked with special needs children?

Yes
No

If yes, explain

If yes, do you have any special training or certificates?

What is your experience working with children of different ages?

Newborn
6-24 months
2-5 years
6-12 years
Teenagers

How long?

Explain

What is your favorite age to work with?

Newborn
6-24 months
2-5 years
6-12 years
Teenagers

What is your least favorite age to work with?

Newborn
6-24 months
2-5 years
6-12 years
Teenagers

Favorite indoor/outdoor activity is

What are your hobbies?

References

Reference #1

Starting date

Ending date

Name

First Last

Phone

Ages of children

Reference #2

Starting date

Ending date

Name

First Last

Phone

Ages of children

Reference #3

Starting date

Ending date

Name

First Last

Phone

Ages of children

Please provide a personal reference (not a relative) who has known you at least 3 years:

Name

First Last

Relationship

Phone

Authorization*

I agree

I acknowledge that Maui Nannies may request a reference check/background check, which may include information on my character, general reputation, education, personal characteristics, driving record, police record, and past employment. I hereby authorize the Agency to obtain any such information. I acknowledge that I have read and understand this statement and that, to the best of my knowledge, the information provided in this application is true and correct. I agree to release and hold the Agency harmless for any act of the employer. I also agree to hold the Agency harmless of any claim as a result of any placement in which I am a part.

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References

Maui Nannies on Instagram

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