Untitled Document

Parent Application

About the Mother
Mother's Name:
Occupation:
Place of Employment:
Daytime Phone:	( ) -
Evening Phone:	( ) -
Best Time to Call:
E-mail Address:
Home Address:
City:
Zip Code:
About the Father
Father's Name:
Occupation:
Place of Employment:
Same contact info as the mother:
Daytime Phone:	( ) -
Evening Phone:	( ) -
Best Time to Call:
E-mail Address
Home Address:
City:
Zip Code:

Please describe your children:
Names	Birth Date	Gender	School Hours
		M F
		M F
		M F
		M F

Have you ever employed a nanny?

Yes

If so, please describe the relationship:

Please list any pets:

Please note anything else about your family/household you feel is important for us to know:

Type of Placement:
Live Out Live In
Full Time Part Time Summer

Days/Hours:

Mon	Tue	Wed	Thu	Fri	Sat	Sun

Salary

Weekly Gross (Before Taxes)	$
Weekly Net:

Benefits:
Vacation Y N
Holidays Y N
Health Insurance Y N

If yes to any, please describe:

	Please check all the duties you would like your nanny to be responsible for related to the child(ren):
	Children's laundry
	Bathing children
	Preparing meals for children
	Daily log of children's day
Other:
Do you want your nanny to transport your children? Y N
If yes, please describe:

Would you provide a car? Y N
Would you reimburse your nanny for mileage? Y N
If so, at what rate?

Are you a non-smoking family? Y N
Please describe the personality of a nanny that would best suit your family (athletic, outgoing, laid back).

Please describe a typical day:

Please describe special requirements you are looking for (i.e., religion, education, experience).

If live-in, please describe living accommodations.

How did you hear about NannyNextDoor?