FAMILY APPLICATION FORM
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Please tell us about your family so that we can begin the selection process of your nanny.
After you have completed the form please send it to us with the non-refundable application
fee in the amount of $150.00.

We are interested in: Live-out ____ Live-in ____ Full time_____ Part time ____

Name of Family: ___________________________________________________________

Address: ________________________________________________________________

City/State/Zip: _____________________________ Home Phone: ____________________

CHILDREN:
Name: ____________________ Age: _____ Birthdate: __________ Sex _____
Name: ____________________ Age: _____ Birthdate: __________ Sex _____
Name: ____________________ Age: _____ Birthdate: __________ Sex _____
Name: ____________________ Age: _____ Birthdate: __________ Sex _____

NANNY'S WORK SCHEDULE:

How many days per week? ______________ Which days? _______________
How many hours per day? _______________ What hours do you prefer? __________
How many hours per week? _____________ Weekly range of pay _______________

(* Nannies are currently earning between $11 and $14 per hour.)

Will you need evenings, weekends, or overnight care? _____________________________
How many paid holidays will you offer? _________________________________________
How many paid vacation days? _______________________________________________
When would you like the nanny to begin? _______________________________________
Do you have a housekeeper or cleaning service? _________________________________
Do you have any pets? ________ Please describe: _______________________________

JOB DESCRIPTION:

Please tell us what you expect from your nanny. ____________________________________________________________________________________
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What light housekeeping duties will you require? ____________________________________________________________________________________
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Do you have an age preference? ________ Please tell us about any qualities which you prefer
NOT to consider. ________________________________________________________
Does your nanny need to be a swimmer? ________ Is a car necessary? _______________
Are there any benefits that you would like to offer to the nanny? ( Example: travel benefits,
health insurance, car provided etc.) ____________________________________________
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MISCELLANEOUS INFORMATION:

Please tell us any information about your family that you feel will help us in the selection process:
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We will call you upon receipt of your application to go over the information and to let you know
about availability of nanny candidates. You will also receive some information about the
interviewing process, guidelines for light housekeeping, and getting started with your nanny.

Thank you for telling us about your family and for choosing NANNY PLACEMENT SERVICE
LTD. for your childcare needs.