Family Application - Portland NanniesPortland Nannies

Anticipated Start Date of Nanny:

Desired Length of Stay for Nanny:

Name

Spouses Name

Address

City

State

Zip

Home Phone

Work Phone

Your Occupation

Spouses Occupation

Nanny’s Anticipated Work Schedule - Total Hours:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Will there be frequent overtime?

Yes

Any flexibility in the hours needed? (Please define)

CHILDREN INFORMATION SECTION

Child 1 Name

Child 1 Sex

Male

Female

Child 1 Age

Child 1 Birthdate

Child 1 School Hours

Child 2 Name

Child 2 Sex

Male

Female

Child 2 Age

Child 2 Birthdate

Child 2 School Hours

Child 3 Name

Child 3 Sex

Male

Female

Child 3 Age

Child 3 Birthdate

Child 3 School Hours

Child 4 Name

Child 4 Sex

Male

Female

Child 4 Age

Child 4 Birthdate

Child 4 School Hours

Is A New Child Expected?

Yes

If Yes, estimated birthday?

FAMILY RELATED INFORMATION

Please describe each child in your family, giving an idea on temperament, likes, dislikes, etc.

Please describe your family (things you enjoy doing together, discipline, philosophies, etc.)

Do you have any pets?

Yes

If yes, what type?

Is nanny responsible for their care?

Yes

Do you follow any dietary practices to which you would like a nanny to adhere?

Yes

If yes, please describe

Who, in addition to parents and children, lives in the home?

Will you have any household help other than the nanny?

Yes

If so, describe:

NANNY RELATED INFORMATION

What do you anticipate nanny’s child care responsibilities to be?

What additional responsibilities (such as housekeeping, errands, etc.) would you like your nanny to perform?

Please describe your ideal nanny:

Would you consider a nanny who wanted to bring her child to work with her?

Yes

If you are an at home parent, please describe how much time you and your nanny will be working together, and what you expect her responsibilities to be when you are home:

Will the nanny be required to drive as part of her job?

Yes

If yes, please explain

Is there a car made available to the nanny to use during work hours?

Yes

If there is no car made available to nanny during work hours, what type of reimbursement will she receive?

SALARY AND BENEFITS

Expected salary per week (Please provide a range that could work)

Expected salary per hour (Please provide a range that could work)

Overtime rate

What benefits will be offered to the nanny? Please check off all that apply and describe in the space provided.

Benefits Description

REFERENCES

We ask that you include two character references for the nanny to call if she wishes to do so. If you’ve had a previous nanny, listing him/her as one would be ideal.

Reference 1 Name

Relationship

Address

Telephone Number

Reference 2 Name

Relationship

Address

Telephone Number

Reference 3 Name

Relationship

Address

Telephone Number

I have read and agree to Portland Nannies Family Policies

Yes

If you are human, leave this field blank.