Family Application

This is the application for searching for a nanny through High Country Nannies. Feel free to call or email me if you have any questions - 303-444-4881.

Family Information
Name:
Date:
Home Phone:
Address: Apt#:
City:
State: Zip:
How did you hear about High Country Nannies? (Please be specific if possible - which newspaper, search engine, etc.)

Wife
First Name:
Last Name:
E-Mail:
Cell Phone:
Business Phone:
Business or Home Fax:
Occupation:
Place of Employment:
Hours per Week:
Does your work require you to Travel? Yes    No
If Yes, frequency and duration:
Husband
First Name:
Last Name:
E-Mail:
Cell Phone:
Business Phone:
Business or Home Fax:
Occupation:
Place of Employment:
Hours per Week:
Does your work require you to Travel? Yes    No
If Yes, frequency and duration:
Applying For
Check all that apply:
Full-time Nanny Live-in Nanny Household Manager On-call Babysitter
Part-time Nanny Live-out Nanny Personal Assistant Temporary
Summer Travel
Date nanny is needed to start:
Do other adults live in your home? Yes    No
If yes, whom?
Child 1
Name:
Sex: Male    Female
Birthdate:
Name of School (with days and hours):
Child 2
Name:
Sex: Male    Female
Birthdate:
Name of School (with days and hours):
Child 3
Name:
Sex: Male    Female
Birthdate:
Name of School (with days and hours):
Child 4
Name:
Sex: Male    Female
Birthdate:
Name of School (with days and hours):
Children
Do any of your children require special needs such as; health, behavior, emotional, or academic concerns? Yes
No
If yes, please describe:

Briefly describe each child's personality and development stage:
1. 
2. 
3. 
4. 

Family activities and interests:
Briefly describe the type of parents you are (easy-going, cautious, strict, lenient, etc.):
Briefly describe your life style:
Special observances (i.e., diet, holidays, religious celebrations, etc.):
Please describe your philosophy of discipline for children:
What roll will you expect your nanny to play in the discipline of your children?
What are the three most important aspects you consider in the care of your children?


Does anyone in your home smoke? Yes    No
Would you consider a nanny who does?: Yes
No

Nanny Requirements
Hours and days needed: Monday       From   to 
Tuesday      From   to 
Wednesday From   to 
Thursday     From   to 
Friday          From   to 
Expected pay range ($10-$20 per hour - Pay is determined by Nanny's qualifications, experience, and job requirements, and is CHILD RELATED ONLY):

$ to
$ per hour
Pay range for additional duties and car use (includes anything OTHER than CHILDCARE):

$ to
$ per hour
Additional benefits offered (Insurance, holidays, vacation days, sick days, bonuses etc):
Qualities important to you in a nanny:
Would you consider a nanny with visible tatoos? Yes    No
Would you consider a nanny with face piercings? Yes    No
Is driving required by the nanny? Yes    No
If yes, please describe:
If yes, please describe authorized usage:
Is cooking for the children expected of the nanny? Yes    No
If yes, please describe:
Describe, in detail, the nanny's responsibilities with your children:
Describe, in detail, the nanny's housekeeping responsibilities in regards to the children:
Will you have a housekeeper in addition to your nanny? Yes    No
If yes, how frequently:
Do you have pets? Yes    No
If yes, please describe:
Have you ever employed in-home childcare providers? Yes    No
If yes,: Live-In    Live-Out
For how long?
Reasons for termination:

** This section is for families searching for a live-in nanny only **

Please describe in FULL DETAIL your live-in nanny's living accommodations:
Is there a car available for the nanny to drive? Yes    No
Do you expect your nanny to:
Eat foods your family eats? Yes    No
Eat meals with the children only? Yes    No
Eat meals alone? Yes    No
Feel free to prepare her/his own food? Yes    No
Other (please describe):
Will nanny be allowed to entertain guests? Yes    No
If so, what rules/guidelines will you request for this situation?
Will your nanny have:
A private room? Yes    No
A private bath? Yes    No
A private kitchen? Yes    No
An apartment facility? Yes    No
A private phone? Yes    No
A phone available for use? Yes    No
A television for private use? Yes    No
Air conditioning? Yes    No
A car for her/his exclusive use? Yes    No
A car she/he shares with family? Yes    No
Comments
Please tell us how we can improve our online application:
BY CLICKING ON THE SUBMIT BUTTON, I AFFIRM THAT I AM THE PERSON LISTED ABOVE AND ALL INFORMATION PROVIDED IS TRUE IN ITS ENTIRETY.

Thank you!

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