Nanny Companions by 0jsPsqI4

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									          Nanny Companions
          Family application
          Linda Brickson
          3281 Conservancy Estates Ln.
          Sun Prairie, WI. 53590
          608-837-9307

Date_____________________________________________
Family name___________________________________________________
Address________________________________________________________________
________________________________________________________________________
General directions to your
home___________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Home phone number(s)__________________________________________________
Home Email____________________________________________________________

Business Contact Information
Mother:
Occupation_____________________________________________________________
Employer_______________________________________________________________
Address________________________________________________________________
Phone number(s)________________________________________________________
Email address___________________________________________________________
Fax number_____________________________________________________________
Hours worked per week__________________________________________________
Does your work require travel____________________________________________
Please explain frequency and
duration________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Father:
Occupation_____________________________________________________________
Employer_______________________________________________________________
Address________________________________________________________________



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Phone number(s)________________________________________________________
Email address___________________________________________________________
Fax number_____________________________________________________________
Hours worked per week__________________________________________________
Does your work require travel____________________________________________
Please explain frequency and
duration________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Family Profile

Names and ages of children living in the
household______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
General description of the position you desire to
fill_____________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Describe your current Childcare
situation________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If seeking a live-in position, please describe living
accommodations________________________________________________________
________________________________________________________________________
________________________________________________________________________
Hours needed___________________________________________________________
If weekend hours, please
describe________________________________________________________________
________________________________________________________________________
Starting date____________________________________________________________
Salary range offering_____________________________________________________
Benefits offering
      Health insurance_______________________________________________
      Paid holidays__________________________________________________
      Vacation pay___________________________________________________




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Preferred age range of
Nanny_________________________________________________________________
Does this position require any travel with the
family__________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Non Childcare responsibilities required for this
position________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Will driving be required for the position____________________________________
Will the Nanny have the use of a family vehicle______________________________
Will you provide mileage reimbursement __________________________________
Comfort level of Nanny planning “outings” for your
children________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Religious orientation_____________________________________________________

Qualifications important to you in a
Nanny_________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Do you currently employ a housekeeper____________________________________
Other adults living in/working in your
home___________________________________________________________________
________________________________________________________________________
 Family activities and
interests________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________



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________________________________________________________________________
________________________________________________________________________

Describe your discipline
approach_______________________________________________________________
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Describe your family
lifestyle_________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Does anyone in your family smoke_________________________________
Do you have any pets_____________________________________________

Does anyone in your family have any special needs (please
explain)________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Other important
information_____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________




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