Family Application

First Name *

Last Name *

Name of Spouse or Partner

Email *

Phone *

Alternate Phone

Address *

City *

State *

Zip *

Is your home accessible to public transportation *
 Yes No

If yes, which train or bus line?

What is your profession *

Your Spouse/Partner’s profession

Does any parent work from home?

Does your family have a pet? If so, please describe.

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?

Are you open to a Manny?
 Yes No

What is your current form of childcare?

How long have you had this childcare arrangement?

If you have a nanny, why is she/he leaving?

May we contact him/her?
 Yes No

Current Nanny's Name?

Current Nanny's phone number?

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

What household responsibilities are required of the nanny? (Please check all that apply)
 Make Child(ren's) bed Child(ren's) laundry Child(ren's) meals Clean child(ren's) toys Light Housekeeping Car pool Transport child(ren) Shopping for child(ren)

This list is not part of a nanny's regular duties and should be negotiated between the family and the nanny. (Please check all that apply)
 Travel with family Pet care Run errands Grocery Shop Vacuuming and dusting Family meal preparation Make family's beds Family Laundry Plant care Other (specify)

Other (If Applicable)

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, include their gender 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)

Briefly describe your family lifestyle. Family hobbies, interest, etc.

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?