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Nanny Tax Calculator - DOC

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					                                          A Brilliant Nanny Place ment Agency
                                        7739 SW Capitol Hwy Suite 200 Portland OR 97219
                                       Ph (503)459-4055 F (503)459-4155 www.abnanny.com

                                               Permanent Client Registration Form

Your Name_____________________________________                        Address  __________________________________________________
Home Phone____________________________________                                 __________________________________________________
Spouse or Partner’s Name_________________________                    Email      _________________________________________________
M om’s Occupation_______________________________                     Dad’s Occupation ____________________________________________
M om Cell Phone_________________________________                     Dad Cell Phone ____________________________
M om Work Phone________________________________                      Dad Work Phone ____________________________
Company Name__________________________________                       Company Name _____________________________
Fax Number_____________________________________
Best way to contact_______________________________

Children’s Names             Date of Birth                 Special Needs
_________________            ____ /____/____               ______________________________________________
_________________            ____ /____/____               ______________________________________________
_________________            ____ /____/____               ______________________________________________
_________________            ____ /____/____               ______________________________________________
_________________            ____ /____/____               ______________________________________________

Date you would like nanny to start     _________
Anticipated Date of Completion If Known _________

Please list the hours you would like the nanny to work:

M onday from____ to ____ Tuesday from ____ to ____ Wednesday from ____ to ____ Thursday from ____ to ____
Friday from ____ to ____ Saturday from____ to ____ Sunday from ____ to ____

Please describe any variations in the above schedule-___________________________________________________________________
Overnights Required- ______________________________________________________________
Travel/Vacations with the family_____________________________________________________
The nanny will primarily be __ home alone with the children ___ home with the children and one or more of the parents

S alary and Benefits

Salary Range between $____ and $____ per hour OR $_______ and $________ per week
Taxes and payroll will most likely be handled by □ Client □ Personal Accountant □ Nanny Tax and Payroll Service (see information on next
page)
Health Benefits ______ yes ______ no ($        or      % per month)
Paid Vacation__ yes ___ no for ____ days per year        Sick Days____ per year
___ Nanny will be paid while family is on vacation or when her services are not required
___ Nanny will provide her own car and be reimbursed for mileage or ___ Nanny will be provided a ___ manual ___ automatic car
Please list paid holidays __________________________________________________________________________________________
Any additional benefits___________________________________________________________________________________________
Nanny will be employed for ___ 3 months ___ 6 months ___ 1 year ___ Other:____________________________________________

□ I do NOT want my anonymous job posting to be visible to potential candidates on www.abnanny.com.

Family Information for ABN and your nanny:

How did you hear about us? □ Yahoo □ Google □ City Search □ Referral (Name________________) □ Yellow Pages □ Other___________

Pets________________________________________              ____ Indoors ____ Outdoors

Please describe any allergies any of your children have________________________________________________________________________
____________________________________________________________________________________________________________________

Please describe any and all activities your children are involved in_______________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

Will the nanny be responsible for managing any of the above activities? Please explain
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________


Are there any other household duties other than childcare you would like the nanny to help you with? Please Explain
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

What would you like a potential nanny to know about your family ? _____________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
What types of activities/clubs are you and/or your spouse involved in and how often?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

Please describe any forms of childcare you have used in the past_________________________________________________________________
____________________________________________________________________________________________________________________

Please list some qualities that you feel would best describe your ideal nanny_______________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

Would you be willing to work with a nanny who has to bring her own child to work with her? □ Yes □ No Provisions:___________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

If hiring a part-time nanny, are you willing to allow another family to hire her on a part-time basis or allow her to accept temporary on-call
positions through A Brilliant Nanny during the hours she is not working for your family? □ Yes □ No □ N/A Provisions:__________________
____________________________________________________________________________________________________________________


*This questionnaire is meant to serve as a template for us to use to get to know you and to find the most ideal childcare for your family. Pleas e
feel free to add any specific requirements, comments, or descriptions regarding the position you are looking to fill. If necessary, feel free to
attach a separate sheet of paper.

Please present this form to A Brilliant Nanny at the time scheduled for a family consultation or mail it to:

A BRILLIANT NANNY
PO Box 19004
PORTLAND OR 97280

For more information on taxes and payroll, visit www.breedlove-online.com or call 1-888-273-3356 for a free consultation. The website
contains a nanny tax calculator that will allow you to estimate your yearly employer taxes and compare gross salary to net salary. Breedlove
makes the whole process very easy and affordable for families.

				
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