Spoonful of Sugar
Nanny Placements
FAMILY APPLICATION
Contact Info
Parent One (first, last):____________________________ SSN:__________
Parent Two (first, last):____________________________ SSN:__________
Address:_________________________________________
City:______________ State:____ Zip:_________________
Home Phone:_____________________
Fax:_______________________
Email:___________________________
Cell(s):_____________________ ______________________
Work Phone(s):___________________ ___________________
Which is the best way to contact you?_________________________
What time of day is most convenient?_________________________
Placement Profile
Are you looking for: Full-time (35+ hrs) ____ Part-time (34 hours or less)____
Live-In____ Live-Out____
Days (please circle all that apply): M-F M T W TH F
From:______am/pm To:______am/pm
Additional (please indicate always/occasional/amount per month): weekends______ evenings______
overnight______
Would the nanny be asked to/expected to travel with the family?______
Please detail any additional information about your schedule (e.g. flexibility, variance, frequency and length of
travel, etc):___________________________________________
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Are you looking for a: permanent placement (minimum 1 yr)____ temporary placement (please indicate
length)________
When are you looking for someone to start?______
Are you planning to do a Nanny Share with another family? (if so, this family must also apply with SOS):________
Do you work: in the home outside the home
Number of children:____ (maximum 4 per nanny)
Child:_____________________________ Age:____ Gender:____ Grade:____
Child:_____________________________ Age:____ Gender:____ Grade:____
Child:_____________________________ Age:____ Gender:____ Grade:____
Child:_____________________________ Age:____ Gender:____ Grade:____
Please indicate if any of the children are multiples:______________
Do any of the children have any physical impairments or disabilities?______
If yes, please explain:______________________________________________________
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Do any of the children have any medical issues (including asthma, frequent ear infections, allergies, etc.)?______
If yes, please explain:______________________________________________________
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Are there any behavioral problems or learning disabilities the nanny would need to be aware of?________
If yes, please explain:_____________________________________________________
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Are any additional children on the way?______ due date:______
Do you have any pets?_____________________________________________________
What activities would you like the nanny to do with your child(ren)?_________________
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Would you be comfortable with the nanny taking your child(ren) on outings?______
If yes, where?____________________________________________________________
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Are there any classes your child(ren) are currently involved in, or will be involved in, that the nanny would take
them to?_______________________________________________
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Would the nanny be doing school drop offs/pick ups?______
Would the nanny have use of a family vehicle?______
Do you have any security devices (e.g. nanny-cams) in your home?______
Please indicate any/all housework (including errands) the nanny would be expected to perform:
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Does your family follow any special diet (e.g. vegetarian, vegan, kosher)?__________
If so, would you prefer a nanny who follows this same diet?______
Has anyone in the household, at any time, in any state, had a criminal record or complaint filed against them?
____
If yes, please explain:______________________________________________________
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Nanny Profile
Please indicate your preferences (if any) as to the following:
Age range:____
Gender:____
Ethnicity:________
Religious background:________
Minimum level of education:________
Would you prefer a nanny who speaks a second language?______
Would a nanny be expected to provide a car for transporting the child(ren)?______
Are there any special skills you would appreciate a nanny being affluent in?___________
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What would you see as the most important qualities in a prospective nanny?___________
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Compensation
Are you planning on paying: hourly salary
(please note that we do not hire out nannies for less than $12/hr, $8/hr if Live-In, or the equivalent of this if
salary)
If hourly, please indicate amount:______
If salary, please indicate amount:______ weekly ______monthly
Will you be offering over-time pay?(hourly only):______
Paid vacation (minimum 1 week/12 months; suggested 2 weeks/12 month):________
Paid sick days (suggested amount 1/quarter):________
Will you be offering health insurance?______
Will you be offering an annual raise in pay?______
Essay Questions (please use an additional sheet of paper if you wish)
How do you see a nannies’ role in your family?_________________________________
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What is your discipline philosophy/method?___________________________________
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How would you describe your family to a prospective nanny?______________________
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How would you describe your child(ren) to a prospective nanny?___________________
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Have you had a nanny in the past?______
If so, please describe you relationship with them. Did you encounter any problems? What were the positives?
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Please take a moment to describe the perfect nanny for your family. What are your priorities? Would you
appreciate someone who is outgoing, easy-going, impeccably clean, organized…? Take some time to think and
be as specific as possible. This enables us to find the perfect person to suit your family.
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