Required fields are indicated with an asterisk (*), but please fill
out the application as completely as you can.
CONTACT INFORMATION
PARENT #1: CONTACT INFO
First Name:*
Last Name:*
Street Address:*
City:*
State:*
Zip Code:*
General Location:
Home Phone:*
Fax:
Cell Phone:
Email:*
Occupation:
Place of Employment:
Work Phone:
PARENT #2: CONTACT INFO
First Name:
Last Name:
Email:
Occupation
Place of Employment
Work Phone:
ABOUT YOUR CHILDREN
CHILD #1
Name:
Date of Birth: (mo/day/yr)
Gender:
--None--
Male
Female
CHILD #2
Name:
Date of Birth: (mo/day/yr)
Gender:
--None--
Male
Female
CHILD #3
Name:
Date of Birth: (mo/day/yr)
Gender:
--None--
Male
Female
CHILD #4
Name:
Date of Birth: (mo/day/yr)
Gender:
--None--
Male
Female
FOR ALL YOUR CHILDREN
School(s) & Hrs Attended:
JOB DETAILS
Start Date For Nanny: (mo/day/yr)
End Date: (mo/day/yr)
Nanny Needed Indefinitely?
Type Of Care Needed:*
Live In
Full Time
Part Time
After School (one school year only)
Summer (one school summer vacation only)
Temporary
Evenings/Weekends (occasional)
Travel (occasional)
For help selecting multiple answers,
click here .
Ideal schedule:
Anticipated salary range? (Pretax)
Benefits:
Paid Vacation
Year End Bonus
Medical Insurance
Use of a Car
Automobile Insurance
Mileage Reimbursement
For help selecting multiple answers,
click here .
1. Do your children need to be transported to/from school/activities?
If yes, describe:
2. Describe any special academic, behavior, or health concerns:
3. Do you have any pets?
--None--
Yes
No
4. If yes, please describe your pets:
5. Are there smokers in your household?
--None-- Yes
No
6. Can the nanny/caregiver smoke?
--None-- Yes
No
Not in house/around children
7. Do you prefer a nanny who swims?
--None-- Yes
No
8. Select all duties the nanny will be asked to perform:
Prepare Meals - Family
Prepare Meals - Child
Laundry - Family
Laundry - Child
Ironing
Clean Bathroom
Grocery Shopping
Care for Elderly
Care for Pets
Errands
House Sit
Light Vacuum & Dusting
Keep Kitchen Straightened
Help with Homework
Carpools
Driving to Activities
For help selecting multiple answers,
click here .
9. List Other Duties:
10. Do You Keep Firearms In The Home?
--None-- Yes
No
11. Are Firearms Locked Up?
--None-- Yes
No
PREVIOUS CHILDCARE ARRANGEMENTS
1. Describe your past childcare arrangements:
2. Why are you changing your current arrangements?
--None--
Recent return to work
First child
Additional children
Dissatisfied with daycare
Dissatisfied with current caregiver
Previous caregiver quit
Change in living situation
Other
3. Describe your ideal nanny/caregiver:
4. Would you consider hiring a nanny who brings a child to work?
--None-- Yes
No
REFERENCES
Please provide one previous childcare reference (non-relative only) if applicable:
Name: (first/last)
Street Address:
City:
State:
Zip Code:
Phone:
Email:
Relationship:
OUR SERVICES
How did you hear about The Nanny Network?*
--None--
Word of mouth
TNN Client Referral
Agency Referral
Retail Store Referral
Internet Search
Advertisement
Website Referral
Yellow Pages
Other
Why did you choose Us?
Positive recommendation
Prior satisfaction with service
Reputation
Rates
Customer service
Service offering
Other
For help selecting multiple answers,
click here .
Please check this box only if you do not wish to
receive future offers and updates on services from The Nanny Network.
Yes, I understand I am responsible
for a $225 fee with the submission of this application, and will be contacted by The Nanny Network to arrange
payment.*
In submitting this application to the The Nanny Network, LLC, I agree
to the following terms and conditions:
Terms of Use . (Includes client agreement & release information).*
