Would you like a nanny? We can find you one. Choose to fill out a full version of the application form or a shorter, quick version. We'll be in touch soon!
Full Form
Quick Form
Personal Information: Parent 1
first name:
last name:
business phone:
business fax:
occupation:
place of employment:
hours per week:
does your work require travel?
Yes
No
How often and for how long?
Personal Information: Parent 2
first name:
last name:
business phone:
business fax:
email:
occupation:
place of employment:
hours per week:
does your work require travel?
Yes
No
How often and for how long?
Family Personal Information (continued)
how many children do you currently have?
do other adults live in your home?
Yes
No
Child 1:
name:
sex:
Male
Female
birthdate:
name of school (with days and hours):
does this child require special needs such as; health, behavior, emotional or academic concerns?
Yes
No
briefly describe each child's personality and development stage:
Child 2:
name:
sex:
Male
Female
birthdate:
name of school (with days and hours):
does this child require special needs such as; health, behavior, emotional or academic concerns?
Yes
No
briefly describe each child's personality and development stage:
Child 3:
name:
sex:
Male
Female
birthdate:
name of school (with days and hours):
does this child require special needs such as; health, behavior, emotional or academic concerns?
Yes
No
briefly describe each child's personality and development stage:
Child 4:
name:
sex:
Male
Female
birthdate:
name of school (with days and hours):
does this child require special needs such as; health, behavior, emotional or academic concerns?
Yes
No
briefly describe each child's personality and development stage:
family activities and interests:
briefly describe the type of parents you are (easy-going, nervous, lenient, &c...):
would you describe your lifestyle as:
Informal
Formal
special observances? (i.e. diet, holidays, religious celebrations, &c...)
does anyone in your home smoke?
Yes
No
will you have a housekeeper in addition to your nanny?
Yes
No
do you have pets?
Yes
No
is the nanny required to feed/care for the pet(s)?
Yes
No
have you ever employed an in-home child care provider?
Yes
No
Nanny Requirements
applying for a nanny that is:
Live In
Live Out
Part Time
Full Time
approximate start date:
days needed:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
specific comments:
hours needed:
specific comments:
if weekend hours, please describe:
preferred age range of nanny (select all that apply):
Under 25
25-29
30-34
35-39
40-50
Over 50
preferred languages spoken:
is driving required by the nanny?
Yes
No
is it acceptable for the nanny to commute to your home by train/bus?
Yes
No
if applying for a live-in, please describe the living accommodations:
if applying for a live-in, is there a car available for the nanny to drive?
Yes
No
please describe authorized usage:
is cooking expected of the nanny?
Yes
No
other qualities important to you in a nanny:
describe, in detail, the nanny's responsibilities with your children:
describe, in detail, the nanny's housekeeping responsibilities:
please describe any additional requirements of a potential nanny that have not been specifically mentioned above:
Compensation
salary range:
Hourly
Weekly
will you be providing any additional benefits (i.e. health insurance, transportation costs, etc.):
how many paid vacation days will you offer the nanny?
when will vacation days be available to the nanny?
will you offer any sick and/or personal days? If yes, how many?
Yes
No
Referral Information
how did you hear about the agency?
