JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
New Family Application
We are excited to assist your family with securing care!
This application will assist us in vetting appropriate candidates for your position.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First and Last Name
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Physical Address (address, city, state, and zip code)
*
Your answer
Phone Number
*
Your answer
We are looking to fill the following role
Nanny
Household Manager
Home Educator
Tutor
Date Night
Personal/Administrative Assistant
Housekeeper
Personal Chef
Night Nanny
Postpartum Support
Other:
We are looking for
Live-out
Live-in
Clear selection
This position is
Full-Time
Part-Time
Temporary/Occasional
Date Night
Event Care
Other:
Clear selection
This position is
Long-term (1 year or more)
Short-term (12 months or less)
Temporary
Other:
Clear selection
Estimated Start Date
MM
/
DD
/
YYYY
How did you hear about E-Nanny
Your answer
Children's Info (Name, Age, Gender)
Your answer
Are you expecting any more children within the year?
Yes
No
Maybe
Clear selection
If any of your children have special, atypical or alternative needs, please describe.
Your answer
Please describe your home dynamic
Busy
Peaceful
Chaotic
Loud
Structured
Unstructured
Organized
Other:
Please describe your parenting model
Authoritative
Attachment
Love and Logic
Whole Brained Child
Progressive
Permissive
Authoritarian
Positive
Babywise
Sears
Gentle
Other:
My children do not enjoy
Your answer
Daily Schedule/Routine
We have one
We'd like one
We don't need one
Clear selection
Eating Habits
Eats almost everything
Eats most foods
Eats some foods
Selective eater
Clear selection
Eating Restrictions
Vegetarian
Vegan
Kosher
Gluten-free
None
Clean
Other:
Clear selection
Are there any allergies (environmental or food)? If yes, please describe.
Your answer
Discipline
Not an issue
Might be an issue
Definitely an issue
Clear selection
Please describe your discipline style/philosophy
Your answer
Please list any household pets (specify indoor/outdoor, breeds, and approximate weight)
Your answer
Will the nanny need to care for household pets ?
Yes
No
Maybe
Electronic Restrictions
Access to electronic media during the nanny's shift
Children have no access to tv, alternative screens (iPad, kindle, etc) or other electronic media
Children have limited access to tv, alternative screens, or electronic media
Children have unlimited access to tv, alternative screens, or other
Please detail any other information we should know about your family (home dynamic, home culture, boundaries, expectations, goals, etc.)
Your answer
Nanny Work Schedule (please detail days and start and end times)
Your answer
Any additional scheduling information
Your answer
Will the nanny need to transport your child(ren)?
Yes
No
Maybe
If yes, what will the nanny use to transport the children?
A vehicle is provided
The nanny will use their vehicle
The nanny will not transport my child(ren)
Clear selection
Hourly Rate
$15-18/hr
$18-20/hr
$20-25/hr
$25-30/hr
Other:
What responsibilities will the nanny have?
Your answer
What qualities are you looking for in a nanny?
Positive
Firm
Nurturing
Outgoing
Punctual
Gentle
Energetic
Interactive
Active
Creative
Athletic
Communicative
Educated
Structured
Mature
Playful
Reliable
Other:
Years of experience preferred
1-3
3-5
5-10
10 or more
Open to all experience levels
Other:
Any additional nanny requirements? (education, particular skills, travel docs, health status, etc.)
Your answer
Are you comfortable with a nanny bringing her own child to work with her?
Yes
No
Maybe (for the right candidate)
Clear selection
What benefits and accommodations will you provide your nanny?
Employee Assistance Program
Major holidays off
Paid vacation
Paid sick time
Mileage Reimbursement (paid for travel at work for work purposes)
Vehicle Stipend (for the car and maintenance of vehicle)
Annual bonus/Incentive bonus
Paid travel with family
Health Insurance Stipend
401k or Investment Stipend
Mental Health Stipend
Tuition reimbursement (for child related courses)
International Nanny Association Membership
Phone
Gym membership
TV (live-in)
Private bedroom (live-in)
Private bathroom (live-in)
Shared bath (live-in)
Other:
Have you ever employed a nanny before?
Yes
No
Clear selection
If yes, please tell us what you liked and disliked about your previous nanny.
Your answer
For what reason is the nanny no longer employed with your family?
Your answer
What are the best days/times to contact you?
Your answer
I prefer to be contacted by
Email
Phone (call)
Phone (text)
Other:
Clear selection
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of E-Nanny LLC.
Report Abuse
Forms
