Family Application

    Parents Names

    Both parents contact numbers

    Nationalities

    Email Address

    Occupations

    Employers

    Home Address

    City

    State

    Zip Code

    Languages spoken at home

    CHILD INFORMATION

    Number of Children

    Names

    Ages

    Gender

    Dates of Birth

    Child’s Interest and Activities

    Are you currently expecting? YesNo

    Due Date

    JOB INFORMATION

    Starting Date

    Job Title

    What hours do you want the Nanny to work?

    Full Time ( 30 hrs or more / wk)Part Time(15-29 hrs/wk)

    Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Saturday

    Sunday

    Total amount of guaranteed hours per week

    Do you require a COVID-19 Vaccinated Nanny and/or other vaccinations?

    Will weekends be required? YesNo

    If yes, how often?

    Will evenings be required? YesNo

    If yes, how often?

    Would you consider a Nanny who wanted to bring her own child to work? YesNo

    If yes, what age range?

    Hourly range (based on duties, experience, number and age of children and education of Nanny).

    Benefits to be provided

    Medical Insurance

    Paid sick day

    Paid Holidays

    Paid Vacation

    Are you prepared to pay Nanny´s Tax?

    Would you be working with a Tax & Payroll Company?

    Describe your home situation (size, formal, casual, condo, house, etc.).

    NANNY DUTIES

    Please check all that apply:

    Run Errands, shopping?

    Homework / Tutor Children

    CookingChildrenFamily

    LaundryChildrenFamily

    Drive ChildrenOwn CarFamily Car

    TravelWeekendExtended

    Care for PetsYesNo

    Swim with Children

    Further Explanations

    Would light house cleaning be required? Please explain

    Do you hire other housekeeping help? YesNo

    If yes, how often?

    Will driving be an essential duty? YesNo

    Is the car available for the Nanny´s personal use? YesNo

    ADDITIONAL INFORMATION

    Describe your family to the candidates.

    Do either parent work in the home? YesNo

    If yes, how often?

    Are there any specific needs? (physical, mental, or emotional) that your Nanny should know about.

    Explain your philosophy about child discipline.

    Have you had a Nanny before? If yes, what has been you experience?

    Give a description of your ideal Nanny.

    When would you like to schedule an appointment to chat with us? Day and time

    How did you hear about our Agency? Are you currently working with another Agency?

    Please give us additional information that would be helpful for us to know.

    Comments.