Nanny Placement Family Application Form

Name
First NameLast Name
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Area CodePhone Number
MonthDayYear
Date
Anticipated Start Date
MonthDayYear
Date
Will your nanny be a live-in or live-out?
Please list the hours and days your nanny will be expected to work.
Please provide the name, gender and date of birth of each child.
Wonderful! Do your children attend school? If so, where and what hours?
Do any of your children have special needs or health considerations or allergies? If so, please explain.
Do you have pets? If so, what kind?
Great! Do you have other domestic help? If so, how often?
What light housekeeping duties will your nanny be responsible for?
How do you handle discipline in your home? How do you want a Nanny to handle discipline?
Pick which words best describes your family?
Have you employed a Nanny or Au Pair before?
Thanks, will your nanny be required to work regularly/scheduled shifts?
What salary range are you offering?
What benefits will you be providing?
How did you hear about Pink Nannies?
Thanks! Will your nanny be responsible for running any errands or grocery shopping on the job? If yes, please list.
Are you open to having a nanny take your children outside of the home for child related activities?
What are 5 of the most important qualities you value in a Nanny?
Thanks!Please list any skills or abilities you desire in a nanny.
Is there any additional information about your family/family situation that our team should know before beginning your search?
Is there anything else that you would like to tell us about your children, family, or the position?
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Application Fee$200.00

Total $0.00

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Buyer Name
First NameLast Name
Buyer E-mail
Should be Empty:

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