Family Application Form We are very excited to assist you in your search for a great nanny! First name *Last name *Phone number *Email *Spouse/Partner's first nameSpouse/Partner's last nameSpouse/Partner's Phone numberSpouse/Partner's EmailStreet Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweIs this your first time hiring a caregiver? *YesNoDid you use an agency? *YesNoJOB DETAILSStart date *Type of Position *Full-time (40+ hours per week)Part-time (20-39 hours per week)TemporarySummerLive-outLive-inSelect all that applyHourly rate *0 / 250BenefitsPaid vacationSick daysMileage reimbursementHealth insuranceAuto insuranceGuaranteed hoursOvertimePersonal daysPaid holidaysPublic transportation reimbursementYearly bonusSelect all that applyNumber of children *Ages of children *Add ages, separated by commasDo you have animals? *Please select an optionYesNoPlease list them hereDoes the nanny need a car? *Please select an optionYesNoDays needed *MondayTuesdayWednesdayThursdayFridaySaturdaySundayFrom *Hours120102030405060708091011Minutes-0030AMPMSelect start hour (AM)To *Hours120102030405060708091011Minutes-0030AMPMSelect finish hour (PM)Do you need help with light housekeeping? *YesNoLight housekeeping *Children's laundryPrepare meals & snacks for the childrenKeeping play areas clean & tidyWash baby bottlesLoad/unload dishwasherOtherPlease select all that applyAre you expecting another child? *Please select an optionYesNoIs there anything else you’d like us to know?0 / 500How did you hear about us? *FacebookInstagramReferred by friend or familyGoogle searchOtherConsent *Yes, I agree with the privacy policy and terms and conditions. Submit
