Personal Information

Household Income:
 $35,000 – 50,000  $50,000 – 70,000  $75,000 & up

Have either parents been convicted of a:
Misdemeanor? Yes No
Felony? Yes No

Do any members of your family smoke?
Yes No

Do you have any pets?
Yes No
If yes, please explain:

Have you ever had a nanny before?
Yes No
If yes, please explain:

How did you hear about Northwest Nannies Childcare Services?
Family/Friends
Internet/Website
Radio/Television/Newspaper Ad
Other:

Job Specifics

1. Date you expect position to begin:

2. How many children do you have?

3. What are their names / sex / dates of birth?

4. What type of nanny are you seeking? (Check all that apply)
Full-time   Part-time   Live-in   Live-Out

 If a live-in, please briefly describe living quarters:

5. Days of the week and hours you expect your nanny to work or be on call:
Sunday Monday Tuesday Wednesday
Thursday Friday Saturday

Hours:

6. Any special skills you want your nanny to have:

7. What are the qualities you’re looking for in a nanny:

8. Do you expect your nanny to travel with you?
Yes No

If yes, how often?

9. Will it be acceptable for your nanny to practice religion in their private quarters (if a live-in )?
Yes No

10. Will you expect your nanny to work on major holidays?
Yes No

If yes, which ones:

11. Will you object to your nanny smoking outside your home?
Yes No

12. Do you expect housekeeping?
Yes No

If yes, explain:


13. Do you expect cooking?
Yes No

If yes, explain:

14. Do you expect driving?
Yes No

If yes, explain:


15. Will your nanny have use of a family car?
Yes No

16. Will your nanny be expected to use her own car?
Yes No

17. If yes, will gas and/or insurance be covered?
Yes No

18. Gross weekly salary that you’re offering:

Is this amount negotiable?
Yes No

19. Benefits: (health insurance, car insurance, vacation time, sick time, etc.)

20. Please discuss any other information that you feel is important to know about your family: (Please feel free to include your job description.)


By clicking on "Submit Application" button, I acknowledge that I will pay the applicable placement fee upon hiring a nanny from Northwest Nannies Childcare Services.