Family Application

Select the service that you are interested in below to begin the application process:

Nanny

Temporary Nanny / Babysitter

Newborn Specialist

Family Information
Password:
Re-Type Password:

Family Last Name:
Home Number:
Home Fax:

Mother's Information
Mother's Name:
Cell Number:
Mother's Email Address:
Home Address:
Home City:
Home State:
Home Zip:

Mother's Occupation Information
Company Name:
Company Address:
Work Number:
Work Fax:

Father's Information
Father's Name:
Cell Number:
Father's Email Address:

Copy Mother's Address
Home Address:
Home City:
Home State:
Home Zip:

Father's Occupation Information
Company Name:
Company Address:
Work Number:
Work Fax:


Children's Information
Name	D.O.B.	Gender	Special Needs/Allergies
		Male Female
		Male Female
		Male Female
		Male Female

Desired Start Date:
SELECT DATE
Sunday	-
Monday	-
Tuesday	-
Wednesday	-
Thursday	-
Friday	-
Saturday	-
	Will weekends be required? Always Sometimes Never

What do you plan on paying your candidate?

Any additional comments:

Industry Standard: 2 weeks paid vacation (you determine probation period - 3,6, or 9 months), 6-8 paid holidays (if required to work - then double time), 2-3 sick days, $.40/mile gas mileage reimbursement (covers all wear/tear on vehicle - oil changes, tires, gas, etc.). Gas mileage reimbursement does not apply if you are providing the vehicle & gas.

Benefits
Paid Vacation	# of Days:
Paid Holidays	# of Days:
Paid Sick Days	# of Days:
Bonus	List When:
Insurance	What Type?
College Course	How Much?

Services To Be Required
Cook for Children
Cook for Adults
Feed Pets
Assist With Homework
Run Errands
Grocery Shop
Unload/Load Dishwasher
Child Related Event Planning
Wash Child's Laundry
Wash Adult's Laundry
Travel
Purchasing Children's Clothes

Temporary Dates Needed As of Now
Dates:	Times:
SELECT DATE	-
SELECT DATE	-
SELECT DATE	-
SELECT DATE	-

Do you have a housekeeper?	Yes No
How often does your housekeeper come?
List in detail, what housekeeping duties will be expected of the nanny:
Are you expecting?	Yes No
Will there be a stay at home parent?	Yes No
If Yes... Who?
Will this be your first nanny?	Yes No

Do you have any pets?	Yes No Please list all your animals:
Are there any firearms in your home?	Yes No
What qualities in a candidate are most important to you?
Please describe the perfect candidate: (age, energy, personality, etc.)

What type of discipline methods are used in your home?

What are your expectations of a newborn specialist?

Would You Allow A Nanny To Bring Her Child?	Yes No
Conditions that will apply?

How did you hear about us?
Yellow Pages	Magazine
Referral	Newspaper
Internet
Please tell us the name of the method of advertising:

List all other agencies you are working with:
What time of day can our candidates call you?
Have you or any of your immediate family ever been convicted of a felony?	Yes No

Please provide a name and phone number of a nanny or childcare provider who has cared for your children:

Name:	City:	State:	Phone:	Years Known:

Friend or relative to contact in case of an emergency:
Name:
Relationship:
Phone Number:

What are two major cross streets?
North/South Street:
East/West Street: