Parent’s Application

Employer Application

In order to submit form you must complete all required fields. Please check to make sure all required fields have been completed prior to submitting. Please also complete and submit Employer Agreement at same time. Thank you.
  • Street, City, State & Zip
  • If yes, please describe
  • If yes, please indicate name, age and if they will be in the home during the nanny's hours
  • If yes, and vehicle is provided, what restrictions and responsibilities will you expect of your nanny?
  • If so, what reimbursement arrangements will be made?
  • ex. To school, from school, to activities, from activities, to friends' homes, from friends' homes
  • If yes, please explain.
  • If yes, please describe.
  • Indicate Monthly, Weekly and Hourly
  • Medical, Dental, Vacation, Sick Leave, etc.
  • If yes, what housework duties (Children's Rooms, Master bedroom, Laundry, Mopping, Vacuuming, Dusting, Misc.)
  • If yes what meals? (Breakfast, Snack, Lunch, Dinner)
  • If yes, what type of pet? What is the pet's name?
  • Please provide name and phone number
  • By clicking Submit I agree that I have completed this application as accurately and precisely as possible. I also have read and agree to the terms in the Employer-Agency Agreement. I understand that any of the aforementioned references can and will be contacted for verification of this information.