Family Application

First Name *

Last Name *

Name of Spouse or Partner

Email *

Phone *

Alternate Phone

Address *

City *

State *

Zip *

What is your profession *

Your Spouse/Partner’s profession

What type of nanny are you looking for?
 Full time (more than 30 hours/week) Part time (less than 30 hours/week) Temp/Summer Nanny Nanny Share

Days needed? Hours needed?

Hourly rate you are seeking to pay?

Desired start date of nanny, if any?

What kind of personality are you looking for?

What are your nanny’s priorities in terms of how she spends her time when your child/children nap?

Other duties?

Is driving required by your nanny?
 Yes No

Is it okay for your nanny to commute by train/bus?
 Yes No

How many children will she care for?

Names of children and ages?

Does your child require special needs such as; health, behavior, emotions, or academic concerns?

Describe each child’s personality and developmental stage?

What’s your parenting style? Do you believe in lots of discipline? Or are you more permissive? (if applicable)

Do you have pets?
 Yes No

Name of your pet/s?

Does your nanny need to care for your pet?
 Yes No

How many paid vacation days will you offer?

How many sick/personal days will you offer?

Are you interested in setting up a nanny work agreement?
 Yes No

How did you hear about Second City Nannies?