Quality Nanny Placements, LLC • Family Application

Family Application
Contact Information
Parent One*

First NameLast Name
Parent Two

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Parent One's Cellphone*

Area CodePhone Number
Parent Two's Cellphone

Area CodePhone Number
Other Phone Number

Area CodePhone Number
Parent One's Email*
Parent Two's Email
Other Email
List your family's need below:
Start Date

MonthDayYear
Children's Ages*
Separate by commas.
Salary Range
Hourly or Salary
Type of Care:

Live InLive OutEither
Nanny Schedule:
Sunday
Type N/A for off day.
Monday
Type N/A for off day.
Tuesday
Type N/A for off day.
Wednesday
Type N/A for off day.
Thursday
Type N/A for off day.
Friday
Type N/A for off day.
Saturday
Type N/A for off day.
Do you have any pets?*

YesNoPossibly in the future
If Yes, what kind?
Dog/s, Cat/s, Reptiles, etc.
Responsibilites & Requirements
Please mark any and all requirements below

LaundryCookingVacuumingIroningHousekeepingPet CareRun ErrandsDrive Children to ActivitiesAbility to SwimOccasional OvernightsCPR CertifiedFirst Aid CertifiedOther
How did you hear about Quality Nanny Placements LLC?
Google, Care, Sittercity, etc.
Additional Notes
Once you submit the application, you will be required to submit the $1.00 deposit

This will be refunded if you do not hire a nanny or credited towards our placement fee if you do
Quality Nanny Placements, LLC • Family Application 2016
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