Family Application

For those fields on this form that don't apply, please enter "n/a" or "not applicable"

Family Background

Parent’s Information (Father's)
Parent’s Information (Mother's)
Do both parents live at this address?

Children’s Information

Childcare Requirements

Childcare is the nanny’s primary responsibility. Please describe in detail the expected duties including childcare:

Please describe any other requirements you may have and the type of person you may have in mind
(age, experience, education, special training or skills, etc). Include any special needs of the children:

Lifestyle & Accommodations

Please describe your family's leisure time activities and general lifestyle:

If this is to be a live-in position, please describe in detail the accommodations you will provide
(bedroom size and location, private or shared bath, TV, furnishings, etc):

Please describe any household pets
Do any family member smoke?

Work Schedule, Salary & Benefits

Normal Work Schedule

Other Hours Required
Travel with family (Vacation and/or Weekend)
Benefits you are willing to offer/consider

(the actual salary/benefits package will be determined between the family and the nanny)


Other Information
Live in or live out?
Short Terms or Long Term?
Do you require the nanny to have her/his own car?
Do you require the nanny to transport children in her/his own car?
If yes, how is the nanny compensated for work related driving?
Do you have any additional information or comments that will help us make the most compatible match for you and the caregiver?
Is all the information on this application complete and accurate to the best of your knowledge?