Candidate Application

Full-Time Live-In Nanny
Full-Time Live-Out Nanny
Part-Time Nanny (less than 35 hours per week)
Part-Time Nanny (15-35 hours per week)
Part-Time Nanny (less than 15 hours per week)
As Needed Nanny/Respite Care 
Family Consultant

First Name:

 Last Name:

Cell Phone:

 Email:

Address 1:

Address 2:

City:

Zip Code:

(5 digits)

State:

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Daytime Phone:

Evening Phone:

Are you a legal citizen or do you have a work visa?: 

YesNo

Driving Information: Please list your driver's license number, make & model of vehicle, license plate number, and car insurance carrier and policy number

Please list any moving violations, citations or accidents (excluding parking tickets):

Please list your most recent employer:

Job Duties:

Education:

Desired hourly wage:

Special Needs Experience:

Autism                                                                         
ADHD/ADD                                                                
Learning Disability                                                    
Physical Disability                                                      
Developmental Disability                                          
Sensory Integration Disorder                                   
Other:  

Other childcare experience:

Specific special needs qualifications (ABA, Floor Time, Special Education):

Desired Start Date and Available Schedule (for temporart assignments, please list hours available each day):

Do you have any issues with pets? If so, describe:

Describe yourself, hobbies, activities, interests:

Other information  including religious observations, activities, interests, housekeeping standards and personality that you think would be helpful:

Please list 3 references including their name, address, email, and phone number. If they are childcare references, please include ages of children and specifics about their special needs:

Referral Agreement: Please read each statement carefully and indicate your agreement by checking each box and entering your name below: 

The information provided on my candidate application is true and correct to the best of my knowledge. I authorize investigation of all statements contained herein.

I hereby authorize Professional Family Consultants, LLC to check my references of past employment and personal history for the purposes of future employment.

I hereby authorize Professional Family Consultants, LLC to run a county, state and national criminal background check, driving history, sex offender registry, and social security verification report.

I understand that Professional Family Consultants, LLC is a domestic staffing agency and does not employ the candidate. PFC assumes no liability or responsibility for any act of an employer or their employee.

I will not work for any family referred to me by Professional Family Consultants, LLC, either directly or indirectly, without notifying the agency.

I will not act in the role of agent by introducing individuals other than myself to clients of Professional Family Consultants, LLC for purposes of employment.

I acknowledge that I have read and agree to the statements made above.

By entering my name, I have read and agree to all statements above:

How did you hear about Professional Family Consultants?