Family Application for a Nanny

Name (First, Middle Initial, Last *(required)
E-mail  *(required)
Address 
City 
State/Province 
Zip 
Country 
Daytime 
Phone 
  Ext.
Best Time 
to Call 
Evening 
Phone 
Best Time 
to Call 
1. When do you need a nanny or mother’s helper to start work?
2. Number of Children, Ages
 
0-18 months 
 
6-7 years 
 
19 mos.-2 yrs. 
 
8-9 years 
 
2-3 years 
 
10-11 years 
 
4-5 years 
 
12+ years 
       
3. Do you have any pets?
4. Interested in hiring: (check all that apply)
Position Average Salary
Live-In Nanny $800/wk.
Live-Out Nanny $800/wk.
Part-Time $20/hr.
Temporary $240/24hrs. or $20/hr.
Baby Nurse $225/24hrs. $325/Twins/24hrs.
Companion $125 daily