NY Nanny family application page

250 West 57th Street, New York, NY 10107 - Phone: (212) 265 3354 - Fax: (212) 265 3361

Family Application

We are looking forward to working with you to help to find a nanny for your family. The information which you provide on the application will help us in the process. We make every effort to be very selective about our nannies and we refer only those nannies to you whom we feel will be a good “match” for your family.

Upon receipt of the application we will call and review it with you. We will then begin the matching and guide you through the hiring process. We will need a signed contract, via fax or mail.

Please answer all questions as completely as possible to ensure a successful placement.

Family Application

Parents:

Father's full Name

Mother's full Name:

Email address:

Home Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Home Fax:

Father's Occupation

Work Phone:

Work Fax:

Mother's Occupation

Work Phone:

Work Fax:

Father’s company name and address

Mother’s company name and address

Does the father work outside the home? Mother?

Children:

Please include a brief description of each child, i.e. personality, temperament , and special needs. If they attend school, please include days and hours.

Name - Age - Sex - Description

Others or additional information

Family Lifestyle

Please briefly describe your family lifestyle, including
activities and interests.

Include any additional relevant information

Are there any pets? Describe:

Does anyone smoke in the home?

yes no

Have their been any incidents of domestic violence in your family that were reported to the police or social service agencies?
If yes, please explain:

Has anyone in your home ever been arrested or convicted for any offense other than a minor traffic violation?
If yes, please explain:

Qualifications of the Nanny

Describe your ideal nanny, i.e. personality and experience

Describe the nanny/family relationship you prefer

Does your nanny need to swim?

Does your nanny need to drive?

Preferred date of arrival

Who is caring for the children now?

Job Requirements

A) Hours

Please note the time the day begins and ends for the nanny.
Include any evenings. Indicate which days the nanny is off:

B) Cooking

Nanny cooks meals for children: all some none

Nanny cooks meals for family: all some none

C) Housekeeping

Nanny is responsible for cleaning. all some

Do you have a housekeeper or cleaning service? If yes, how often?

D) Laundry

Nanny does the children's laundry:

yes no

Nanny does the family's laundry:

yes no

E) Driving

Nanny drives children to activities: yes no

Grocery shops? yes no

Does errands? yes no

F) Net Salary Ranges:

Live-In $ /week

Live-Out Part Time $ /hr

Live-Out Full Time $ /week

Nanny Accommodations & Privileges ( if applicable)

Living Quarters: Private room Separate level

Bathroom: Private bath Shared bath

Car Privileges:	Exclusive use
	Frequent personal use
	Limited personal use

Referral Source

Please tell us how you heard about our agency, i.e. friend, Child Care
Council, newspaper advertisement (please indicate which newspaper).

All other questions and comments email at: info@nynanny.com

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New York Nanny Center, Inc.
250 West 57th Street, New York, NY 10107
Phone: (212) 265 3354 - Fax: (212) 265 3361
Email: info@nynanny.com