Name *

First Name

Last Name

Phone

(###)

###

####

Preferred Method Of Contact

Email

Text

Phone Call

Have you employed anyone in your home in the past?

Yes

No

Are there cameras in your home?

Yes

No

Anticipated start date? *

MM

DD

YYYY

Benefits offered please check all that apply. *

Please note some industry standards include two weeks paid vacation, stipend towards medical benefits, sick days, paid holidays

Paid holidays

Paid sick time

Health insurance stipend

Full health insurance

Mileage reimbursement and or Public transportation Pass

Use of Nanny car

Food stipend

Gym stipend

Stipend towards further education/ workshops

Retirement option

Will you require your nanny to drive while at work?

Yes

No

Do either parent work remotely from home? *

Yes one

Yes Both

No

Are there any pets in the home?

Yes Dogs Only Home

Yes Cats Only Home

Both Cats and Dogs

No Fur babies for us!

Any food allergies in the home?

Yes

No