House Nanny Home Care Application

Name*

First Last

Address*

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

Phone*

Email*

Are you 18 years of age or older?*

Yes
No

Are you either a U.S. citizen or an alien authorized to work in the U.S.?*

Yes
No

Have you ever worked with pets before, owned pets or have been around pets in any long-term capacity? If so, what kind of pets? Please explain.

Start date availability?

Are you able to work

Holidays
Nights
Daily Drop-ins

Desired territory [side of town]

How did you learn about this opening?

Education

High School

School Name:	Graduated?	Course of study:

Technical School

School Name:	Graduated?	Course Study?

College/University

School Name:	Graduated?	Course Study?

Post-Graduate Education:

School Name:	Graduated?	Course Study?

Other education, training or special skills:

Skills

Would you be opposed to taking care of reptiles and rodents?

Yes
No

If yes, please specify kind of exotic/rare pets you would be comfortable caring for:

Do you have pet or home related allergies?

yes
no

please explain

What kind of pets are you most familiar with caring for?

Work Experience

Employer:

Address

Street Address City State ZIP Code

Start Date:

End Date:

Position held:

Reason for Leaving:

Supervisor's Name & Title

May we contact?

Yes
No

Description and Duties:

Starting Composition

Ending Composition:

Employer

Address

Street Address City State ZIP Code

Start Date:

End Date:

Position Held:

Reason for Leaving?

Supervisor's Name & Title:

May we Contact?

Yes
No

Description of Duties:

Starting Composition:

Final Composition:

Please list below 2 past residences you’ve lived.

Previous Address

Street Address City State ZIP Code

Landlord/Property Management name

how many years did you live here?

Address

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

Landlord/Property Management name

how many years did you live here?

References

Identify two persons who know you professionally and two who know you personally, excluding family members, beginning with the most recent.

Name*

First Last

Phone*

Email*

Address*

Street Address City State ZIP Code

Identify Relationship*

Years Known*

Name*

First Last

Phone*

Email*

Address*

Street Address City State ZIP Code

Identify Relationship*

Years Known:*

Name*

First Last

Phone*

Email*

Address*

Street Address City State ZIP Code

Identify Relationship*

Years Known:*

Name*

First Last

Phone*

Email*

Address*

Street Address City State ZIP Code

Identify Relationship*

Years Known:*

Disclaimer: The information requested and provided will only be used for a thorough background check. All information provided will remain confidential.

Drivers License #*

Drivers License State*

Date of Birth*

MM

DD

YYYY

Social Security #*

Have you ever been arrested?

Yes
No

please indicate the cause, location and date.

Authorization and Acknowledgements*

I authorize and Acknowledged

I affirm that the information I have provided in this application is true to the best of my knowledge, information, and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading
information in this application is grounds for discharge.

Signature*

Date*

MM

DD

YYYY

Application for Professional Petsitting

Application

Education

Skills

Work Experience

Please list below 2 past residences you’ve lived.

References

Disclaimer: The information requested and provided will only be used for a thorough background check. All information provided will remain confidential.

House Nanny Pet Sitting