Application for Nanny Services

Please fill out the form below

Guardian 1 Work hours
Occupation/Place of Emp. Work # Fax
Guardian 2 Work hours
Occupation/Place of Emp. Work # Fax
Home Address: City Zip
Home Phone: Email Address:
What is the best way to reach you?
Child's Name(s) Date of Birth Gender School Arrangements/Hours
Please note any special needs
Other members of household (relatives, domestic help, older siblings etc.)
Name Age Relationship to child
Name Age Relationship to child
Do any members of household smoke?
Pets(please list) Swimming Pool
Please list previous child care situations, providers, environments (day care, nannies, relatives)
NANNY POSITION INFORMATION (Please check only one)
Full-time      Part-time      Full-time Live-in      Summer
Full-time Mommy Nanny      Part-time Mommy Nanny  (Mommy Nanny’s bring their child and earn a lower salary)    Nanny-Share (2 families to share 1 nanny)
Nanny start date Days/Hours Salary range (Gross)
Benefits: Paid Vacation weeks after months. Paid sick days    Holidays with pay
Would you be willing to contribute towards health insurance? amount /month.
Will any weekends be requested? Frequency
Will overnights be needed? Frequency Rate of Pay
Describe any travel plans contemplated during the Nanny’s stay:
With Nanny Without Nanny
Please describe anticipated transportation needs
Will a car be provided? if no, will a car allowance be provided for transportation of children?
Caregiver Characteristics: Please list important qualities you feel the Nanny should possess.
Caregiver Responsibilities: Please list caregivers duties regarding your child(ren).
Housekeeping Duties: Please list the housekeeping duties you will require of your nanny.
Family Information: Please list any information about your family that may help us in making a successful placement.
Please describe what you feel to be the ideal working relationship between your family and your nanny.
How did you hear about Babies to Boomers?
Are you currently working with any other agencies to find a nanny? If yes, please list

I understand that the full placement fee will be charged to my credit card if I do not pay Babies to Boomers the referral fee before a Babies to Boomers nanny begins her employment. I have filled out the application as accurately as possible, including reasonably accurate hours, duties and pay ranges and understand that the credit and replacement policy will be null and void if the position is not consistent with the above job description. I also agree to submit a contract signed by the nanny and myself prior to the nanny’s first day of employment.

I have read and understand the terms of this agreement
I Agree
I disagree
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