The Nanny Authority - Family Application

"The Most DEDICATED & CARING Nannies"

Dear Family,

Please complete the following on-line family application. Our staff will get back to you within one business day. There is no charge to complete this application. We look forward to speaking with you.

* Required Information

Contact Information
First name:	*
Last name:	*
Street Address:
City:	*
State:	*
Zip Code:	*
Day Phone:	*
Evening Phone:
Fax:
eMail:	*

Spouse's Full Name (if applicable):
Your occupation:	*
Spouse's Occupation (if applicable):

When do you need a nanny to start?	*
Are parent(s) employed outside the home?	Yes No *
If parent(s) work in the home, who works in the home and what hours:

Job Specifics
Do you need a full-time, live-in nanny?	Yes No *
Do you need a full-time, live-out nanny?	Yes No *
Working Hours for the Nanny:	*
What days will the nanny have off?	*
Gross weekly salary you are offering:	*
Nannies usually work 5 days a week, 10-12 hours a day. If you have needs in addition to this, please specify:
How many children do you have and what are their ages? *
Boys: Their ages (respectively):
Girls: Their ages (respectively):
If any children are in school, list hours and days of the week:

Are you expecting any more children in the next year?	Yes No *
If yes, when and how many?
Do any of your children require special care, medication or therapy of any kind?	Yes No *
If yes, specify:
Is the nanny required to cook for the family?	Yes No *
Is the nanny required to cook for the child(ren)?	Yes No *
Does your family have any special dietary considerations?	Yes No *
If yes, please specify:

Living accommodations(*):	Private Residence Apartment Townhome
Approximate size of home in square feet:	*
Will the nanny have her own bedroom?	Yes No *
Will the nanny have her own bathroom?	Yes No *
If no, who will share the bathroom?
If you will provide a separate living area for the nanny, what is it? (i.e. separate wing, private entrance, apartment above garage, carriagehouse):
Do you have any other adults who reside in your home?	Yes No *

Do you have a regular housekeeper?	Yes No *
Do you have other household members?	Yes No *
If yes, please list:
Will the nanny have use of a car for work & personal use?	Yes No *
If yes, is it a 3rd car designated only for the nanny?	Yes No *
Comments on car use:
Will the nanny travel with you?	Yes No *
If yes, when and where?
Do you have any pets?	Yes No *
If yes, please specify:

How many nannies have you had in the past 3 years?	*
How long did each one stay? Where were they from? Why did they leave?
Please describe favorable/unfavorable experiences with previous nannies:
List qualities that you are looking for in a nanny (i.e. ex-swimmer, athletic, college background):

How did you hear about us? Please list the specific newspaper, magazine or web site.
	Newspaper
	Magazine
	Web Site
	Other