Family Application

Are There Any Smokers In Your Household:

Yes

No

Type of Service(s) Requested

1 yr of experience)

2-3 years of experience)

3-5 years of experience)

5-10 years of experience)

10-20 years of experience)

Child 3 - Date of Birth:

Desired Nanny Hours/ Times on Tuesday

Parent Name

Desired Nanny Hours/ Times on Sunday

We will require your nanny to receive the COVID-19 Vaccine for this position ?

Yes

No

No Preference

Do you work from home?

No

Yes

Occasional

Please Select the desired amount of Child Transportation:

Daily

Weekly

On Occasion

None

Will you Require your Nanny to go on Vacation with you?

Yes

No

It is a possibility

Cell Phone 2:

Is this a Live-In Position?

Yes

No

Potentially

Child 2 - Full Name:

Number of Nannies Your Family Has Had In The Last 5 Years:

Family Street Address:

Please select all responsibilities 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

Family Laundry

Would you Consider Sharing a Nanny?

Yes

No

It is a possibility

Child 1 - Full Name:

Previous Child Care References:

Child 4 - Gender:

Male

Female

Please select you homes cleanliness level

Needing Assistance

Average

Neat & Orderly

Meticulous

Child 1 - Date of Birth:

City, State, Zip code:

The information provided in this document is accurate to the best of my knowledge.

How Did You Hear About Us?

Desired Nanny Hours/ Times on Saturday

Child 3 - Gender:

Male

Female

Parent Name

If yes, Can you Please Describe Accommodations:

Child 4 - Full Name:

Desired Nanny Hours/ Times on Thursday

The information provided in this document is accurate to the best of my knowledge.

Please include a family photo on your account *

Desired Nanny Hours/ Times on Monday

Home Phone Number

We will require a flu shot for this position ?

Yes

No

No Preference

Will Occasional Overnight Stay be Required?

Yes

No

It is a possibility

Do you work from home?

No

Yes

Occasional

Child 2 - Gender:

Male

Female

I approve the information provided in this document to be shared with potential candidates

Yes

No

Desired Nanny Hours/ Times on Wednesday

Cell Phone:

Desired Nanny Hours/ Times on Friday

Child 3 - Full Name:

Please list employment title / employer

Please list your preferred start date

Parent 2 Name

Child 2 - Date of Birth:

Please list your Families Interests and Activities

Please list employment title / employer

Child 4 - Gender:

Male

Female

Type of Pets:

Please list any additional children that may be in your family:

Child 1 - Gender:

Male

Female

Preferred Salary up to

Parent Name

Email 2:

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Please Describe an Average Day, Including Household Duties, Which your Nanny Would Encounter:

Type of Service(s) Requested

Full Time Nanny

Part Time Nanny (20 hours or less)

Email:

Would you be Interested in a Nanny with their own Child to Accompany them?

Yes

No

It is a possibility

​​​​Above & Beyond Nanny Services, Inc.

Above & Beyond Nanny Services, Inc.