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Application for Nanny

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Name *
E-mail Address *
Describe arrangement needed *	Live in full time Live in part time Live out full time Live out part time Temporary, two weeks or less Temporary, up to 30 days Temporary, up to 90 days Per diem (1 or 2 day cleaner only)
Mother's first and last name *
Street Address: *
City
State
Zip code
Home Phone
Cell phone
Fax
Occupation
Business Phone
Business Fax
Father's first and last name
Street address
City
State
Zip code
Home phone
Cell phone
Fax
Occupation
Business Phone
Business Fax
Marital Status
If separated or divorced, who has custody?
What are the visitation rights?
Are there any other adults living with you?	Yes No
Personal References #1
Phone number
Personal References #2
Phone number
Name of 1st child to be cared for
age
sex	male female
Name of 2nd child to be cared for
age
sex	male female
Name of 3rd child to be cared for
age
sex	male female
Name of 4th child to be cared for
Please list any special needs the children may have or any behavioral issues that applicants need to be made aware of. (neglecting to list this information will cause your contract to be cancelled)
number and type of pets
Is there another language besides English spoken in your home?	Yes No
If yes, what language (s)
Do you have any need to carry out specific religious beliefs in your home?	Yes No
What is the approximate square footage of your home?
How often do you travel?
Describe the days and times that you will need coverage. (This must be filled out completely) Employees should not be expected to work excessive hours.
Sunday *
Monday *
Tuesday *
Wednesday *
Thursday *
Friday *
Saturday *
total hours: *
Job Description (If you have children under the age of 5 and they are not in school, nanny will only do light housekeeping while children are napping unless this is a mother's helper position, where another adult would be able to oversee the children
Errands	Yes No
Housekeeping? If yes, please list:	Yes No
Laundry	Yes No
vacuuming	yes no
Cooking	Yes No
Pet care	Yes No
Other
Hourly rate offered (please see caregiver rates guide) *
Transportation
Will nanny do any transporting of children?	Yes No
Will you provide the nanny with a car?	Yes No
If no, how do you reimburse the nanny for travel? Minimum reimbursement is .41 per mile	No Selections
If you have had in home private employees in the past, please describe what your last experience was and how it ended.
Where did you hear about South Florida Nannies?
Comments or questions:
Please select the name of the coordinator that assisted you regarding this application. *	Cristy Brenda Jodi Lucy Margie Rod none

* Fields marked with an asterisk are required fields

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Forms number 2 - 5, located on the previous page, must be submitted along with your application in order for the interview process to begin. These forms must be printed, signed, and faxed back to our office. The application will be forwarded to our customer service department automatically.