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Online Family Application
Family Packet
Refer a Family
Testimonials
   

Family Application

   
Your Name (required):
Your Email (required):
Home Address:    
City: State, Zip: ,
Home Phone:  
     
Personal Information
Parent 1:
Name:
Business Phone:
Email:
Occupation:
Place of Employment:
Hrs worked per week:
Does your work require travel?
Yes  |  No
Do your work from home?
Yes  |  No
If you work from home, please explain your scheduling and the setting:

Parent 2:
Name:
Business Phone:
Email:
Occupation:
Place of Employment:
Hrs worked per week:
Does your work require travel?
Yes  |  No
Do your work from home?
Yes  |  No
If you work from home, please explain your scheduling and the setting:
Family Information:
Number of children:
Child #1:
Name:
Date of Birth: (e.g. mm/dd/yyyy)
Male or Female?
Male  |  Female
Does your child require any special needs such as: behavior, health, emotional or academic concerns?
Yes  |  No
If so, please explain:
Does your child participate in any extra curricular programs that would require the nanny to participate in?
Yes  |  No
If so, please list:
If your child attends school, please indicate location an schedule:
Briefly describe your child's personality and development stage:

Child #2:
Name:
Date of Birth: (e.g. mm/dd/yyyy)
Male or Female?
Male  |  Female
Does your child require any special needs such as: behavior, health, emotional or academic concerns?
Yes  |  No
If so, please explain:
Does your child participate in any extra curricular programs that would require the nanny to participate in?
Yes  |  No
If so, please list:
If your child attends school, please indicate location an schedule:
Briefly describe your child's personality and development stage:

Child #3:
Name:
Date of Birth: (e.g. mm/dd/yyyy)
Male or Female?
Male  |  Female
Does your child require any special needs such as: behavior, health, emotional or academic concerns?
Yes  |  No
If so, please explain:
Does your child participate in any extra curricular programs that would require the nanny to participate in?
Yes  |  No
If so, please list:
If your child attends school, please indicate location an schedule:
Briefly describe your child's personality and development stage:

Child #4:
Name:
Date of Birth: (e.g. mm/dd/yyyy)
Male or Female?
Male  |  Female
Does your child require any special needs such as: behavior, health, emotional or academic concerns?
Yes  |  No
If so, please explain:
Does your child participate in any extra curricular programs that would require the nanny to participate in?
Yes  |  No
If so, please list:
If your child attends school, please indicate location an schedule:
Briefly describe your child's personality and development stage:

Family Lifestyle:
What qualities are most important to you in a nanny?
What is your family's philosophy regarding discipline?
Does your family have any special observances?  (i.e. diet, holiday, religious celebrations)
Do you encourage play dates?  At your home and/or away?
Are there any pets in your home?
Yes  |  No
If so, please describe:
Are there additional adults that live in your home?
Yes  |  No
If so, please explain:
Does anyone in your home smoke?
Yes  |  No
Do you have a housekeeper in addition to your nanny?
Yes  |  No
Please describe your neighborhood (accessible to transportation, parking available, parks, etc):
Have you ever employed an in-home childcare provider before?
Yes  |  No
If so, how was your overall experience?
Any additional comments you would like to share to help us get a better understanding of your family's needs?
Job Specifics:
Applying for:

Full Time Permanent Placement (Live In Nanny)

Full Time Permanent Placement (Live Out Nanny)

Part Time Permanent Placement Level 1 (Live Out Nanny)

Part Time Permanent Placement Level 2 (Live Out Nanny)

Temporary Placement
Occasional Sitters
Travel Only Nanny
If you are applying for a live-in nanny, please describe living accommodations:
 (please note Neighborhood Nannies must have their own private bedroom and we strongly encourage
a private bathroom as well)
Start Date: (e.g. mm/dd/yyyy)
Days Needed: Hours:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Do you require any flexibility? (i.e. evenings, weekends, accommodate business or leisure travel..)
Preferred language spoken?
Is the nanny expected to drive?
Yes  |  No
Will a family vehicle be provided for her or will she need her own?
What chores do you expect the nanny to do?
Will the nanny be responsible for preparing meals?
Yes  |  No
Describe what a nanny's daily responsibilities with your child would be?
Who may we thank for referring you to our agency?
Compensation:
Will you be paying the nanny Hourly or Weekly?
Hourly  |  Weekly
Please list the amount you will be paying the nanny:
Will the nanny be paid weekly or bi-weekly?
Weekly  |  Bi-weekly
Please check the benefits you will be providing:

Health insurance

Transportation costs

Sick/Personal Days
How many vacation days will be available and when will they become available?
Please describe any compensation for Overtime?
Any additional benefits that the nanny will receive?