Hometown Nannies plus LLC - Family Application Form

Hometown Nannies Plus LLC Full Service Domestic Employment Agency in CT, NY

Family Profile Online Application: Family Information

Family Surname: *Required

Home Phone: *Required

E-mail address: *Required

Please verify your e-mail address:

How did you hear about us? *Required

Start Date:

Mother's Name:

Father's Name:

Street Address :

City/Town: State: Zip:

Home Fax:

Father's Cell:

Mother's Cell:

Mother's Business Address (if applicable):

Mother Work E-mail:

Business Phone:

Business Fax:

Fathers Business Address (if applicable):

Business Phone:

Business Fax:

Father Work E-mail:

Children's Names	Date of Birth	Age/Sex	Health





Is this a blended family? Yes No
IF Yes, please explain briefly:

Please explain any health problems:

Who is currently caring for your children?

Plans to have another child?
Yes No

How Soon:

Types of pets:

Who cares for them?

Childrens Daily Routine: Please describe briefly

Children's Day:

Nanny's Day:

Mom's Day:

Dad's Day:

Family Profile Online Application: Employee Requirements

Your Ideal Nanny

Have you had a Nanny Before? Yes No

Should Nanny address you by your first name? Yes No

Will your Nanny be a friend or an employee? Friend Employee

For how many years will you require a Nanny?

Please select some preferences you would like in a nanny:

Outgoing Personality:	Essential Important Unimportant
Sense of Humor:	Essential Important Unimportant
Athletic:	Essential Important Unimportant
Artistic:	Essential Important Unimportant
Is a teacher:	Essential Important Unimportant
Musical:	Essential Important Unimportant
Has a Drivers License:	Essential Important Unimportant
Drives a Stickshift (Manual Transmission Auto):	Essential Important Unimportant
Is willing to travel:	Essential Important Unimportant
Other preferences:

Schedule

Nanny will be on duty:

hours

days per week.

Working any evening hours? Yes No

How many per week?

Nanny's Day(s) Off?

(they should be two full days together, usually weekends)

Will nanny be asked to work any weekends? Yes No

If so, please explain:

Your Home & Neighborhood

Style of home:

# of bedrooms / bathrooms

Is there a Playroom | Swimming Pool | Yard | Other

Is your residential area Rural | Suburban | Urban

How many other nannies are within walking distance? Driving Distance?

How far to: Shopping Entertainment Library Train Bus Airport

Population of your town:

Nearest big city:

Use of car? Yes No Own phone? Yes No Own TV? Yes No Visitors? Yes No

Applies to live-in employees only:

Is nanny bedroom on same floor as family? Yes No Approx. size of room?

Is there a separate bathroom for nanny? Yes No If shared, with whom?

Lifestyle

Please list parents hobbies:

How often do you entertain at home? Not often Sometimes Often

How often do you go (without kids) in the evening? Not often Sometimes Often

Are there any special needs/disabilities in your family?

Do you have any special dietary restrictions?

Do children from a previous marriage visit? Yes No How often? Not often Sometimes Often

Will nanny be asked to travel with family? Yes No

Housekeeping

Children are your Nanny’s Priority. We recommend a weekly service or housekeeper to keep the house clean which will allow the Nanny to do her job. Nannies do LIGHT housekeeping, which includes the following: Children’s meals/dishes; tidying up the kitchen after meals; children’s laundry; cleaning /tidying up children’s bedrooms, bathrooms and play areas.

Who cleans your house?

How often? Not often Sometimes Often

In addition, do you need your Nanny to:

Feed Pets Do light cooking Run errands Grocery shop Laundry Other

Employment Matters

Weekly salary range (Net)? $

Health Benefits?

Vacation/Paid Holidays? Yes No

Salary review? Yes No How often?

Will you pay your Nanny for an occasional sick day? Yes No

Who will watch the children if the nanny is sick?

If Nanny uses her own car on the job, will you reimburse him/her at the IRS per mile rate? Yes No

In your experience, what qualities in your employee, would most contribute to a successful long term professional relationship?

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