Registration

Parent/Guardian

Name*

Address

City, State and Zip Code

Phone*

Email*

Current Employer

Job Title

Work Address

Work Phone

Work Email

Additional Parent/Guardian (if applicable)

Name

Address

City, State and Zip Code

Phone

Current Employer

Job Title

Work Address

Work Phone

Work Email

Children

Child's Name And Age

Other Information

What type of role are you looking to fill? (For example, Nanny, Household Manager, Home School Provider, Special Needs Professional, Nanny/Household Manager, Newborn Care Specialist, etc.)

Does your child or children have any medical conditions or special needs that we need to be aware of? If so, please explain.

Please describe the days and times that you will needs your caregiver to work each week. Please include any flexibility you may have.

What is your ideal start date? Are you looking for a long term or short-term commitment, please explain?

Would you like your caregiver to live in or live out of your home? If live in what kind of housing accommodations are you offering?

Will your caregiver need to have a driver’s license?

Will your caregiver need to have a car? If not, will you be providing a car?

Is there parking available for your caregiver? If so, is it street or private parking?

What is your pay scale for qualified candidates?

Are there any other special considerations that we need to be made aware of as we conduct your search?

Please provide us with a written job description in your own words:

By submitting this form, I acknowledge and agree that any applicants representing The Nanny Poppins Agency shall not be contacted or hired without first providing the Agency with a copy, signed by me, of the Agency Fee Agreement, and payment of associated fee(s) stated in this agreement.

Registration

Parent/Guardian

Additional Parent/Guardian (if applicable)

Children

Other Information

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