Family Application

Rainbow Nannies has prepared the following check list to help identify your needs, which will allow us to refer the best and most suitable Nanny for your Family.

FAMILY INFORMATION

Name:

Address:

City

State

Zip

Phone

Home

Work

Cell

Fax

CHILDREN'S INFORMATION

Name	Age	Gender	Date of Birth

Will there ever be additional children to care for (i.e., step-children, friend or relative's children?

NANNY WORK SCHEDULE

The Nanny will be required to work an average of

hours per week, as follows:

Day of the Week	Start Time	End Time	Total Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Miscellaneous or other Hours that may be required:

Which Holidays will Nanny have off?

Will Nanny be paid for Holidays not worked?

yesno

Will Nanny be entitled to Vacation Pay?:

yesno

if yes, how may days?

Will the Nanny's vacation be identified by the family or the Nanny?

FamilyNanny

How many sick days will the Nanny be allotted per year?

Will compensation be provided?

YesNo

Nanny Services Check List

PAYROLL INFORMATION
Payday:		Weekly on MTWThF
		Every other week on MTWThF
		1st & 15th of the month
		Other
Will you withhold taxes? YesNo
Will health insurance be provided? YesNo

DUTIES: Childcare
Childcare Morning Care:	Waking the ChildrenPreparing BreakfastPreparation of School LunchesDressing for SchoolDriving To School
After School:	Assisting with HomeworkHaving Friends over for/or Driving to Play DatesDriving to LessonsActivities or Sports
Evening Care:	Meal Preparation for Children and/or Entire FamilyBath TimeReading
Miscellaneous	BottlesDiapersStroller WalksSwimmingAdministering Medications
Laundry:	NoneChildren OnlyEntire Family
Housekeeping:	(Specific Duties expected):

Meal Preparation	(Occasionally: Always) (Which Meals?) (Will Meal Plans or Recipes be Provided?)
Driving:	If driving is required, will you provide a car or is the Nanny required to provide her/his own?
Errands:		Grocery, Clothing, & Other Shopping:
		Taking Children to Doctor, Dentist, Orthodontist, & Other Appointments:
		Car Wash/Maintenance:
		Prescription Pick Up:
		Dry Cleaning:
		Other:
Pet Care: (Walking, Feeding, Brushing, Cleaning the Yard: Cages or Tanks):
Miscellaneous:
Travel	Will Travel be required? YesNo		If so, how often?	Travel mileage:
	Is there Additional Compensation during Travel? YesNo
	Will the family provide advance cash for the child/children's incidental expenses?					YesNo
	If not, what is your reimbursement policy?
Meals for the Nanny:	Will the Family provide meals or is the Nanny expected to bring her/his own?				YesNo

LIVE IN INFORMATION

Is the Nanny required to stay 7 days a week?	YesNo
Will the Nanny be expected to leave weekends or other times?	YesNo
What type of Bedroom Accommodations will be provided?
Where will the Nanny shower, etc.?:
Will the Nanny be invited to have meals with family?	YesNo	If not, what arrangements will be made?

Will Family provide Nanny with specific foods of her preference?	YesNo
Will Nanny be permitted to have friends or family members visit?	YesNo

Applicant Signature:		Date:
Agency Signature:		Date:

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Rainbow Nannies: Nanny Agency in Los Angeles, Orange County

Family Application

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