Your Information
Full Name
*
Phone
*
Email
Address
City
State
Postal Code
How did you hear about The Nanny Agent?
*
(If a friend or family member referred you, we would love to say thank you!)
Google search
Friend/Family
Social Media
Other
Service Information
What type of care does your family need?
*
Please select all that apply.
Newborn Care Specialist
Full-Time Nanny
Part-Time Nanny
Temporary Nanny
Other Position (if not listed in the drop down above.)
When do you need help?
*
Ongoing
Casual
Full or Part-time?
*
Full-time
Part-time
Are weekends required?
Yes
No
Start Date
*
Start date is flexible
Schedule
*
Mon
From:
To:
Apply to all
Tue
From:
To:
Apply to all
Wed
From:
To:
Apply to all
Thur
From:
To:
Apply to all
Fri
From:
To:
Apply to all
Sat
From:
To:
Apply to all
Sun
From:
To:
Apply to all
Schedule may vary
No. of Children?
*
N/A
1
2
3
4
5
6
7
8
9
10
>10
Ages of Children?
Are You Expecting?
Yes
No
No. of Adults in the house?
1
2
3
4
5
6
7
8
9
10
>10
Is cooking required?
Yes
No
Do you have pets?
*
Yes
No
Kinds of Pets
Is traveling required?
Yes
No
Do you require swimming?
Yes
No
Do you require driving?
Yes
No
Is a car provided?
Yes
No
Describe Parking Situation
Hourly Rate
*
$
Start Date
*
What time?
*
START TIME
END TIME
My schedule may vary
Number of Children?
*
N/A
1
2
3
4
5
6
7
8
9
10
>10
Ages of Children?
Where do you need care?
*
Use my home address.
Address
Address 2
City / Suburb
State / Territory
Postal / Zip Code
Emergency Contact
*
Emergency contact phone
Name of emergency contact
Relationship to you
Any additional responsibilities?
Select all that apply
Light housekeeping
Meal preparation
Laundry
Homework help
Errands/grocery shopping
Your ideal caregiver:
Select all that apply
Is comfortable with pets
Willing to drive children
Has own transportation
Job Description / Duties
Any special needs or allergies?
Submit