Family Application

Family Application

We are looking for: (please click all that you are willing to accept) 

Full-Time Live-In Nanny (35 hours or more per week)

Full-Time Live-Out Nanny (35 hours or more per week)

Part-Time Nanny (15-35 hours per week)
   
Part-Time Nanny (less than 15 hours per week) 

In-Home Respite Care              

Parent 1 First Name:

Parent 1 Last Name:

Parent 1 Cell Phone:

Parent 1 Email:

Parent 2 First Name:

Parent 2 Last Name:

Parent 2 Cell Phone:

Parent 2 Email:

Address Street 1:

Address Street 2:

City:

Zip Code:

(5 digits)

State:

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Daytime Phone:

Evening Phone:

Child Information-Please include number of children, name(s), age(s), gender(s), allergies and school/routine information:

 Special Needs:

Autism                                                                         
ADHD/ADD                                                                
Learning Disability                                                    
Physical Disability                                                      
Developmental Disability                                          
Sensory Integration Disorder                                   
Other:  

Other special needs information:

Specific special needs qualifications desired:

Do you have pets? If so, please describe:

Describe your ideal Nanny:

Any specific requirements desired?

Other information that will help us match a Nanny with your family including religious observations, activities, interests, housekeeping standards and personality of parents:

Desired schedule for the Nanny including hours and days per week. Also include when you would like the Nanny to start:

Salary Information: Please give a salary range for the position, dates of payment, and whether you will withhold taxes:

Benefits: What benefits, if any will you provide?

What type of childcare have you had in the past? Please share any favorable or unfavorable experiences you have had that will aid in the matching process:

Hours, Rules and Routines-Please describe specific routines that are important to your family (bedtime, mealtime, television/outside play, and discipline)

How did you hear about Professional Family Consultants?

Payment of Initial Membership Fee: