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PARENT'S INFORMATION
Parents Names
Both parents contact numbers
2nd number
Nationalities
Email Address
Occupations
Employers
Home Address
City
State
Zip Code
Languages spoken at home
CHILD INFORMATION
Number of Children
Names
Ages
Gender
Dates of Birth
Child’s Interest and Activities
Are you currently expecting?
Yes
No
Due Date
JOB INFORMATION
Starting Date
Job Title
What hours do you want the Nanny to work?
I am hiring nanny Full Time (30 hrs or more / wk)
Monday. Ex: 9:00am to 5:00pm
Tuesday. Ex: 9:00am to 5:00pm
Wednesday. Ex: 9:00am to 5:00pm
Thursday. Ex: 9:00am to 5:00pm
Friday. Ex: 9:00am to 5:00pm
Saturday. Ex: 9:00am to 5:00pm
Sunday. Ex: 9:00am to 5:00pm
Total amount of guaranteed hours per week
Do you require a COVID-19 Vaccinated Nanny and/or other vaccinations?
Will weekends be required?
Yes
No
If yes, how often?
Will evenings be required?
Yes
No
If yes, how often?
Would you consider a Nanny who wanted to bring her own child to work?
Yes
No
If yes, what age range?
Hourly range (based on duties, experience, number and age of children and education of Nanny).
From $
To $
Benefits to be provided
Medical Insurance
Yes
No
Paid sick days. Enter # of days
Paid Holidays. Enter # of days
Paid Vacation. Enter # of days
Are you prepared to pay Nanny´s Tax?
Yes
No
Would you be working with a Tax & Payroll Company?
Yes
No
Describe your home situation (size, formal, casual, condo, house, etc.).
NANNY DUTIES
Please check all that apply:
Run Errands
Shopping
Homework
Tutor Children
Cooking
Children
Family
Laundry
Children
Family
Drive Children
Own Car
Family Car
Travel
Weekend
Extended
Care for Pets
Yes
No
Swim with Children
Further Explanations
Would light house cleaning be required? Please explain
Do you hire other housekeeping help?
Yes
No
If yes, how often?
Will driving be an essential duty?
Yes
No
Is the car available for the Nanny´s personal use?
Yes
No
ADDITIONAL INFORMATION
Describe your family to the candidates.
Do either parents work at home?
If yes, how often?
Are there any specific needs? (physical, mental, or emotional) that your Nanny should know about.
Explain your philosophy about child discipline.
Have you had a Nanny before? If yes, what has been you experience?
Give a description of your ideal Nanny.
When would you like to schedule an appointment to chat with us? Day and time
How did you hear about our Agency? Are you currently working with another Agency?
Please give us additional information that would be helpful for us to know.
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