hhhhhh

FAMILY REQUEST FOR A NANNY

To begin a customized search for your nanny, you can contact our office to have a Family Request sent to you by mail or fax.

For more immediate service, complete and submit the following form. Once received, a licensed and experienced child care counselor will be in touch for a personal consultation and to clarify the details of your search.
 

Please list this position as CONFIDENTIAL.
We currently employ a nanny and do not wish to alert her of our search.
YES       NO      Our current nanny is aware of search.

FAMILY INFORMATION:

Mother's Name (Last, First) Father's Name (Last, First)
Mother's Work Phone and Fax Father's Work Phone and Fax
Mother's Work Fax Father's Work Fax
Mother's Cell Phone Father's Cell Phone
Mother's Employer/Occupation Father's Employer/Occupation
Will either parent work from an office in the home while the nanny is on duty? Yes        No

Home Phone
             
Home Fax
           
Home Address (street)

Home Address (city, state & zip)

e-mail:
  Mother Father Family

Do both parents reside in the home?     Yes      No
If no, please explain:

CHILDREN:
Name
Age
Birthdate (month/year)

Do you plan to have more children?      Yes      No      Maybe
If yes, when?

Please define any medical, social, or emotional concerns regarding the children.



Please define any food or respiratory allergies regarding the children.

What best describes your family lifestyle?    Formal   Informal   Reserved   Outgoing

Family Interests & Hobbies


Special Family Observances (holidays, diet, etc...)


Do any family members smoke?     Yes      No

Family Pets? (If yes, please describe type and number)

POSITION DESCRIPTION:

Require
Live-In Nanny      Live-Out Nanny      Either Live-In or Live-Out Nanny   

Desired Start Date

Schedule

Monday Start (AM):      End(PM):     Not Required
Tuesday Start (AM):      End(PM):     Not Required
Wednesday Start (AM):      End (PM):     Not Required
Thursday Start (AM):      End (PM):     Not Required
Friday Start (AM):      End (PM):     Not Required
Saturday Start (AM):      End (PM):     Not Required
Sunday Start (AM):      End (PM):     Not Required

 

 

 









Do you employ a cleaning service/housekeeper?        Yes      No
If yes, how often? Daily      Weekly     Bi-weekly      Monthly

Do you require nanny to have own car?      Yes      No

How long do you intend to employ a nanny?

Duties

Children's Laundry Family Laundry Transport Children Family Meal Preparation
Light Housekeeping Vacuum Run Errands Pet Care
Grocery Shop Travel with Family    



 

 

Other Duties (please describe):

 

Benefits/Compensation

Weekly Salary Range (please specify Gross or Net)    
Holiday Pay     
Sick Pay          
Vacation Pay   
Bonus              

Health Insurance:      Yes, full coverage provided    Offer stipend towards coverage    None provided

Provide Use of Car:   While on duty    While on duty and off hours    None provided

Live-In Nanny Accomodations (check all that apply)

 Private Quarters     Please Describe:

Private Bedroom and Private Bathroom

Share Bathroom     With Who?

TV and/or Radio Provided in Nanny's Room

Telephone
Line provided for Nanny    Use of family phone    Nanny responsible for long distance

Meals
Prefer taken with family    Prefer not taken with family    Nanny's choice      

Please tell us about your history regarding nanny employment. List how many nannies you have employed and the duration of their employment with your family.
 We have never employed a nanny before.

Occassionally a former nanny or an applicant with child care experience and/or child related education searches for a position where she can bring her own child. Do you wish to consider such an applicant for your position?
                                                           YES      NO      POSSIBLY

ADDITIONAL COMMENTS TO ASSIST WITH REFERRAL (optional):

Would you be interested in purchasing our Pre-employment Packet? (what's this?)
                                                        YES      NOT AT THIS TIME  

         

(Back to NannySitters' Homepage)