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Client Application

Name *
E-mail Address *
Date *
Date Nanny is needed *
Address *
City *
State *
Zip *
Home Phone *
Work Phone Numbers
Occupation
Fax *
How did you find out about us?
Children's Names, Ages, Sexes *
Preferred Age Range of Nanny
Salary Range for Nanny
Preferred Training for Nanny
Required Experience of Nanny
Preferred Personality Traits
Is travel with family required? *
Homework with Children
Other duties
What Would the Work Hours Be?
What Days of the Week?
Living arrangements
  Check all that apply below
  Separate Quarters
  Separate Bedroom
  Separate Bath
  Private Entrance
  Private TV
  Private Phone
  Pets
How Many Vacation Days After 6 Months?
Paid Holidays?
Sick Leave Per Year?
Health Insurance
Other Benefits
  We/I understand and agree that if our/my vacation schedule and that of the Nanny do not coincide, the Nanny will continue to be paid during the time we/I are vacationing.
  Check all that apply below
  Light Housekeeping
General Housekeeping
  Cooking
  Laundry
Is Driving Required on the Job?
Is Nanny Expected to Use Own Car?
If Yes, is there a Car Allowance?
Is Transportation to Job Provided?
Where will Nanny be Required to Drive?
Will Clients Car be Available for Personal Use?
Does the Nanny have to Swim?

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