Family Application

Fill out this form so we can have all the proper info for finding you the perfect nanny!

MAKE SURE YOU ANSWER EVERY QUESTION THAT HAS A RED * ASTERISK TO THE RIGHT OF IT. THANK YOU.

Parents Name * First Last
First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Home Number * ### - ### - ####
Cell Phone * ### - ### - ####
Mothers Employer *
Employer Phone # ### - ### - ####
Mothers Occupation
Fathers Employer *
Employer Phone # ### - ### - ####
Fathers Occupation
What kind of assistance are you looking for? *
Nanny House Manager Mother’s Helper
Child 1 Name * First Last
Birth Date * MM / DD / YYYY
Gender
Male Female
Child 2 Name First Last
Birth Date MM / DD / YYYY
Gender
Male Female
Child 3 Name First Last
Birth Date MM / DD / YYYY
Gender
Male Female
Child 4 Name First Last
Birth Date MM / DD / YYYY
Gender
Male Female
Specify type of employment required. *
Full Time Temporary Live In Part Time Permanent Live Out Summer Care Sitter Service
Please describe your family’s lifestyle and leisure activities. *
Type of household pets.
Are there any smokers in your household? *
No Yes
Do your children require any extra attention due to their special needs? *
Please list previous child care references.
Number of nannies your family has had in the last five years. *
Describe your family’s housekeeping standards. *
Slightly Messy Average Neat & Orderly Meticulous
Please describe any religious practices, preferences, or obligations that occur in your everyday life that your nanny would encounter.
Please check the six characteristics you would like your nanny to possess. *
Reserved Open Minded Accommodating Adventurous High Energy Enthusiastic Happy Patient Detail Oriented Confident Friendly Strict Emotional Affectionate Organized Outgoing Athletic Musical Intelligent Calm Flexible Avoid Conflict Religious Nurturing
What would be the ideal schedule for your nanny?
Sunday AM-PM
Monday AM-PM
Tuesday AM-PM
Wednesday AM-PM
Thursday AM-PM
Friday AM-PM
Saturday AM-PM
Will you require your nanny to go on vacation with you?
No Yes
Will there be occasional overnight stays required?
No Yes
What salary would you prefer to pay your nanny? *
What childcare experience range would you prefer? *
Would you consider sharing a nanny? *
No Yes
Please list responsibilities that you will require your nanny to perform , aside from child-care. *
Light Housekeeping / General Pick Up Errands Family Cooking Grocery Shopping Purchase Gifts Ironing Children’s Laundry Baking Family Laundry None
Would you be interested in a nanny with their own child? *
No Yes
Is this a live-in position? *
No Yes
If yes, describe accommodations.
Please describe an average day, including household duties, which your nanny would encounter.
Amount of child transportation. *
Daily Weekly None
How did you hear of our service? *
Friend MN Parent Google Family Times Yellow Pages Kids Directory Other
Agreement

Please type your full NAME and DATE to confirm the information provided in this document is accurate to the best of your knowledge.
Full Name and Date *
Must be at least 1 characters. Currently Used: 0 characters.

Please type your full name and today's date. Thank You.
Full Name and Date
Must be at least 1 characters. Currently Used: 0 characters.

This form is for the second parent if needed. Thank You

Family Application

What would be the ideal schedule for your nanny?

Agreement