NANNY APPLICATION 847-331-3304      Fax: 847-444-1937      fivediamondagency@yahoo.com    NAME:   BIRTH DATE:   LIVE-IN JOB OR COME AND GO?   ADDRESS/CITY/STATE:       WHOM DO YOU LIVE WITH?   ARE YOU A SMOKER?   PHONE NUMBERS (list two):       DAYS/TIMES YOU CAN GO ON INTERVIEW:   WHAT COUNTRY ARE YOU FROM?   WHAT LANGUAGES DO YOU SPEAK FLUENTLY?   ARE YOU IN SCHOOL NOW?  WHEN?   ARE YOU SINGLE/MARRIED/ENGAGED/DIVORCED?   DO YOU HAVE YOUR OWN KIDS?  HOW OLD ARE THEY?       WHO TAKES CARE OF YOUR KIDS WHEN YOU WORK?   DO YOU DRIVE IN THE U.S.?   DO YOU OWN A CAR?   ARE DOGS and/or CATS IN THE HOME OKAY?   WILL YOU PROVIDE CLEANING SERVICES TO THE FAMILY?   ARE YOU A U.S. CITIZEN?   DO YOU HAVE A GREEN CARD?   HAVE YOU EVER BEEN CONVICTED OF A CRIME?   HOW LONG ARE YOU PLANNING ON STAYING AND WORKING IN THE U.S.?   REFERENCES: (Names and phone numbers of all families, starting with the most recent/current job first – and show dates of employment):                       Please include with this application copies of your drivers license, social security number, car insurance card, also CPR, diplomas or certificates.