In order for us to fully serve your family’s needs, please fill out the form below. If you need assistance, please call 888-849-6090. 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 Email Current Employer Job Title Work Address Work Phone Work Email Children Child's Name And Age Child's Name And Age Child's Name And Age 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.