Family Application

Print Form

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

Email

H

W

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?

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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