Application Form (Child Care)

Date:

Name/Name of Spouse:*

Occupation:

Address:

Email:*

Phone/Text:

Children: Name: age:

Any special characteristics/health issues we need to know about?

Household members:

Service Start date-Length of service:

Job description:

Do you need a nanny who drives? Yes/No/Open to Either:

Days nanny will work:

Hours:

Live-in/Live-out:

If live-in do you have a room for the nanny: Please specify w/bathroom/in-law suite?

How many rooms in the home?

Description of an ideal nanny:

Have you had a nanny before? Reason for leaving?

Languages spoken/Regional background:

Cooking required: If yes, please specify veg/non-veg/type of cuisine

Salary:

Pets:

Payment method: W-2/Check/Cash

How often paid: Weekly/Bi-weekly

How did you hear about us:

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