Parent One (first, last):
Parent Two (first, last):
                      Address:
                            City:
                         State: Zip:
             Home Phone: Home Fax:
                       E-mail:
 Parent 1 Bus. Phone: Ext: Bus.Fax:
                       E-mail:
 Parent 2 Bus. Phone: Ext: Bus.Fax:
                       E-mail:

           Position Type : Live In/Residential Nanny Live Out Nanny Governesses Nanny Managers Personal Assistants Nanny Temps House Manager Housekeeper HouseMan/HandyMan Estate Manager   


          Schedule Type: F/T P/T Temporary

                   Schedule: Mon-Fri Flexible Over Night(s)
                         Other:
                        Hours:

                 Approximate start date of job:

Proposed salary bracket of job (hourly, monthly, yearly):

                                  Number of children:

 Age and Gender of Each Child:

 

       Is a baby due: Yes No           Date Due: Future Possibility

Are there any illnesses, allergies, syndromes, behavior patterns, mental, emotional, or physical disabilities or other special needs that the nanny will have to be alert for, care for or be specially trained for? If so, please describe them as accurately as possible:   

The age range I prefer is: * No preference 21-25 26-30 31-40 40+

* Subject to availability

Aside from childcare, a normal nanny position includes laundry for the children, meals for the children and cleaning the kitchen after the meals, maintaining the children's bathroom, children's rooms and play areas and any misc. duties related to the children. The nanny's own room and bathroom, if applicable, are also her responsibility. Are you expecting any other housekeeping duties from the nanny? If so lease list them in detail:

 

    Do you have a house cleaner or service? Yes No

     How many X per month:

     Have you had caregivers before? Yes No

Why did they leave the position?        

How many caregivers have you had in the last three years?

 Were there any problems with you previous caregivers?

Please select only one: I am registered with other agencies and/or intend to seek nanny candidates through alternative sources. I am working exclusively with Elite Alternatives to secure a nanny.

I prefer to interview nanny candidates at Elite Alternatives.
I prefer to interview nanny candidates at my home.

The best times for me to interview candidates are: Evenings Days Weekends Week-days

Best Times:

*Please note this is an initial application form.
Please check over the information in this form now.