Hire a Household Staff & Employer Application

Client (Employer) Questionnaire
Client Full Name #1
Client Full Name #2
Primary Home Address
Street Address
Address Line 2
City
State
Zip code
Contact Info
Client Email #1
Client Email #2
Client Phone #1
Client Phone #2

Where are you employed, and what is your title?
Company or Organization #1
Company or Organization #2
Title #1
Title #2
Time you leave in morning #1
Time you leave in morning #2
Time you return home #1
Time you return home #2
Frequency and duration of travel #1
Frequency and duration of travel #2

Type of employee needed
(Nanny Only) Please check what type of candidate best describes what you are looking for:* You may check more than one category.
- Young, Single Persons:
  They have extensive babysitting and/or daycare experience and are interested in working as a nanny for a year or two. These nannies may currently have a job that does not offer the same personal rewards that being a nanny and caring for children would offer or they may be taking a break from college or suspending a long-term commitment to another career. These nannies are usually active, energetic and open to new experiences.
- Older, more Mature Persons:
  They may have raised a family of their own and who are drawn to in-home child care because they enjoyed caring for their own children or may have watched children in their own home while raising their children. Education, background and life experiences are varied with this type of nanny candidate.
- Individual Professionals and Specialists:
  These Individuals consider themselves child care professionals and specialists. Some nannies have degrees in early childhood education or elementary education or have a specialized nanny training certificate. Many have worked several years as nannies. Persons in this group consider being a nanny their career.
- Other
Briefly describe the personalities, characteristics and lifestyle of the members of your household and a typical day
Describe personality and characteristics of your ideal candidate
Please describe the main duties required
Is driving a requirement for this position?
- Yes
- No
Are you comfortable with a nanny bringing your child(ren) to places like the park, children's museum, story hour at the library, the zoo or play dates with other children?
- Yes
- No

Work Schedule
Is this a short term or long term position?
- Short Term
- Long Term
Desired Start Date
End Date (Short Term)
Hours Per Day/Number of Days Per Week?
Approximate Start Time and End Time
How did you hear about us?
Additional information you would like us to know about your family or details about the position

(Please fill this out to the best of your knowledge and we will discuss this in detail at our meeting and help customize a job description.)
Gross Salary Range
Number of paid sick/personal days
Number of paid vacation days and number of paid holidays
Will you provide "tax free" dollars towards a monthly wellness stipend?
- Yes
- No
Approximate Amount
Will a vehicle be provided to use during working hours?
- Yes
- No
If no, will gas money be provided?
- Yes
- No
CAPTCHA

Client Questionnaire

Step 1 of 6

Client (Employer) Questionnaire

Primary Home Address

Contact Info

Where are you employed, and what is your title?

Description of Family/Household

Work Schedule