< Sitter Solutions -  Nanny Application Please note most fields are Required on the application.  After you submit your application you will be contacted for an interview time Your name: Address: Cell: Phone: e-mail: Emergency  Contact: (name & relationship) Emergency  Contact Phone number: Please list all addresses for the last 5 years: Social Security Number: Date of Birth (optional): Driver's License Number: Exp. Date Yes No Have you ever been licensed in another State? Yes No Any tickets, arrest, charges, or convictions If yes, please explain: No Yes US Citizen? Have you ever been accused or substantiated as a perpetrator of child abuse or neglect investigated by a child-related social services agency? Yes No If yes, please explain: EDUCATION: College: Name: City & State GPA Year of Graduation Degree High School: Name: City & State GPA Year of Graduation Degree Other: (GED, Vo-tec, etc. Name: City & State GPA Year of Graduation Degree Please list any extracurricular activities while in High School and/or College: EXP Date CPR Yes First Aid? No Yes No EXP Date List any Child Development, Elementary or Special Education Classes: Yes Any experience with special needs in children? No Employment History: Employer 1: Add & Phone Hourly Rate Position Dates (to/from) Reason for Leaving: Employer 2: Add & Phone Hourly Rate Position Dates (to/from) Reason for Leaving: Employer 3: Add & Phone Hourly Rate Position Dates (to/from) Reason for Leaving: References: Name & Relationship Add & Phone Name & Relationship Add & Phone Name & Relationship Add & Phone *** Please have at least 2 written letters of recommendation.  You can bring them to the interview or have them e-mailed. Do you have your own Car? Full coverage Insurance? Yes No Yes No How far are you willing to drive one way to work? Yes No Liability only - Insurance? Disclaimer: We reserve the right to reject any candidate. To the best of my knowledge, all information on this application is true.  I understand that any false or misleading information or omission of pertinent information will result in the rejection of my application., or in dismissal if discovered subsequent to my association with Your Sitter Solution, LLC. Yes No I agree to the above Disclaimer Disclosure: