Family Application

Tell Us About Your Family

APPLICANT

*Name:

*Address:

Occupation

Do you work from a home office?

YesNo

Phone

*Email

*Are you a U.S. Citizen?

YesNo

Preferred contact method:

SPOUSE OF APPLICANT

Name

Address

Occupation:

Does your spouse work from a home office?

YesNo

Phone

Email:

Is your spouse a U.S. Citizen?

YesNo

CHILDREN

*Name, Age, and Sex of All Children:

*Allergies:

*Special Requirements or Needs of Children:

HOUSEHOLD GENERALLY

*Has your family had a nanny before?

YesNo

*Have you worked with a nanny agency in the past?

YesNo

*Is your family fluent in any languages in addition to English?

YesNo

If yes, please explain:

How would you describe your nanny's working environment? (Select all that apply)

*Do you have any pets?

YesNo

*If yes, do you require care for your pets? Please explain:

*Please describe your ideal nanny.

*Please describe daily tasks you would expect your nanny to perform.

*Please describe how you heard about our agency.

NANNY SPECIFICATION

*Position Needed:

*Which service tier best fits your needs?

*Position Start Date:

Position End Date:

*Hours of Childcare Needed:

*Hourly Rate Range:

*Would you like to use one of our recommended payroll companies?

YesNo

*It is industry standard to offer your nanny guaranteed hours, 2 weeks paid vacation (one week nanny's choice and one week family's choice), 3-5 sick/personal days per year and all major holidays paid. Do you agree to offer these benefits?

YesNo

If no, please explain:

*Do you plan to offer your nanny any of the following benefits? (Select all that apply)

*What vaccinations do you require your nanny to have? (Select all that apply)

Other

*Will you require your nanny to wear a mask while working in your home?

YesNo

*Will you require your nanny to travel with your family on vacations?

YesNo

*Will you require your nanny to drive?

YesNo

Family Photo (optional)

Select File