Family Application

Type of Position:

If "Other", what type of position

Application Date (YYYY-MM-DD)
Desired Start Date (YYYY-MM-DD)
How did you hear about GLS Noble Nanny and Domestic Staffing?
Mother’s Full Name
Father’s Full Name
Home Phone
Mother’s Cell Phone
Father’s Cell Phone
Father’s Occupation
Place of Employment
Mother’s Occupation
Place of Employment
Please Describe Your Children (Names, Ages, Genders)

Have you ever employed a nanny? YesNo

Do you observe any religious dietary laws or have dietary restrictions in your home? YesNo
If Yes, Please explain

Will the nanny have use of a vehicle? YesNo

Will the nanny be covered by your car insurance? YesNo

Is there access to public transportation? YesNo
If yes, type of local transportation

Job Duties, Expectations and Compensation

Hours of work per week
Start Time
Finish Time
Evening Care required? YesNo
If yes, how often
Days Off
Weekly Salary
Hourly Salary
Overtime Pay
Overnight Pay
Benefits & Perks: (i.e., health insurance, phone allowance, cable, travel with family, tuition, paid vacation, holidays off,bonus, etc.)
Please list the qualities you are looking for in a Nanny:
What accommodations will you provide your Nanny? (i.e., bedroom, private or shared bath, TV, phone)

Are there smokers in the house? YesNo

Do you have pets? YesNo
If yes, please specify
List Caregiver duties and responsibilities regarding your children (i.e., activities, transportation, etc.)
List housekeeping duties:
List any other information that would help us in making a successful placement for your family:
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